HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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BUilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce.FL 34982
Phone:(772)462-1553 Fax:.(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end'of line
PROPOSED IMPROVEMENT LOCATION ,a ` ,. t
Address:."--�u f c � Gm C3 r-V r A 'breve- Fo Pi e'-r-
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Legal Description: t jC)2ce P -(,t Il c IJ.I. ..I Lo J'N-
Property Tax ID#: C( L D — 001 -OCb9 -70W Q Lot°No._ j
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:. i
DETAILED DESCRIPTION ,OF
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Additional wo.r'tob e fperformedFy un,_er t Is permit-c eC a. appy:
HVAC. .Gas Tank FIGas Piping Shutters. a`Windows/Doors
Electric D Plumbing OSprinkle.rs Generator Roof Roof pitch
Total Sq. Ft of construction: SQ.Ft.of First Floor:
Cost.'of.Construction::$ ���_. Utilities: Sewer ESeptic Building Height:
OWNER%;LESSEE r` ` CONTR`ACTOR
Nam eg2n, r Name: T
Address Company:
City:(y,-�- etct State: T� Address: Ave—
Zip Code: �9y 9 Fax: KIIA- City: f C i-e- State: �---'
Phone No. u l o-a53 Zip Code ";Wq a Faxed
E-Mail: �J Phone N �D
Fill in fee simple Title Holder on next page;(`if different E-Mail:
from the Owner listed above) State or County License:. CaG;
if value of construction is$2500 or more,a RECORDED Notice of Commencement'lls required. I,
SUpwPLEi�IiENTL 1✓dNSTRUCYtONLIEN CAWINFt3RNiATiON
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DE5IGNER/ENGINEER: N Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip:; 'Phone zip:., Phone:
FEESIMPLE_ TITLE HOLDER: _ Not Applicable BONDING COMPANY:. Not Applicable
Name: Name:
Address: Address:
City: City:
Zip;, Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do.the Work and'installation as indicated.
I certify.that no work or installation has commenced prior to the issuance of a permit.
St:Lucie.County makes no representation that is granting a permit will authorize the peri-nit holder to Build the.subject structure,
which`is.in conflict with any applicable,Home Owners Association rules,bylaws or and covenants:that may restrict or prohibit such
structure.Please consult with your Home'Owners•Association and review your deed for any restrictions which mayapply.
In consideration:of the granting of this requested'permit,Wo hereby agree that I will;in all respects .perform the work
in accordance with the:approved plans,the Florida Building Codes and.St..Lucie CountyAmendnients.
The.following building.permit applications ate exempt from undergoing a full concurrency review:room additions,,
accessory structures,swimming.pools,fences,wails,,signs,screen rooms and accessory uses to another;non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement,may result irryour`paying,twice for
improvements.to you'property:.A Notice of Commencement-must be recorded and posted:oh the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencin work or-recotding your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID�IIQ4Q STATE OF FL
COUNTY OF, COUNTY'OF "-�
The forgoing ins" u entwas acknowledged before me The forgoing ins'u' ent was acknowledged before:me
this 7 ..day of. 20 by this day of 20 19 by
Name'of p rso! aking statement Nanie of per n making statement
Personally Known.' OR Produced Identification Personally Known OR Produced identification
Type*.of Identification Type of identification
Produced Produced
I
(Signat re of N ic. tateof (Signature 'f N tate of,-Florda
Commission No. � (Seal) Commission N
' JENNIFER E CPiGAS
*P� JENNIFEK E.CA(3AS �NotaryPubiia,State of Fiorida
REVIEWS. FRONT '� * l isai.lo ,a.GG2MdQR PLANS VEGETATION o., - Cammissi nExpirea0913012022 . I
COUNTE. REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE '
COMPLETED
Rev.8/2/27