HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: h z Permit Number:
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
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENTLOCATION:
Commercial
Residential C1'
Address: % C W (7 11 -J`D' C.;. 2 14:L 8� �%
Legal Description: 2, 5 -dj 12c SZ -0/1-14 -e- 1—u ! ,�', v ,9111 _ 3/,
Property Tax ID #: _ 0U = U L) 4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION[ OF WORK:
CONSTRUCTION INFORMATION:
N
Additional work to be p6Ff6Fmed under this permit - check all that appy.
,�Vlechanical _ Gas Tank —Gas Piping i Shutters Windows/Doors
Flectric ^ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �j�( (IBJ Utilities: —Sewer —Septic Building Height:
OWNERAESSEE:
CONTRACTOR;
Name dllylJ
Name: G
i,
Address: 0/ la. a2 I
Company: sasko
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City: `ji -� /U C"..Q_ _ State: F41"
Zip Code: '2)47 �_6 Fax:
Phone No. 7.72,_ 2�71--, ,j e -'j 7 %
E -Mail:
Address: e_r4 G (9c;"$c3 V
City: - -{ - " (c- state:^
Zip Code: , Fax:
Phone No-'/-? - L¢ C' - 7 q
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail LLQ
DC7
State or County License
,
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 permit 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 may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financirrg, consult with lender or an attorney before
commencing work or recording your Notice of Commencement,
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instr ment
was acknowledged before me
this day of 20_ by
this _1'--L day of
20—Lq by
C l
0..m •--�t,�..�
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known
OR Produced Identification
Type of Identification
Type of Identifica - n
Produced
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(Signature of Notary Public -State of Florida }
(Signa ure o o ary u
ic- State of Florida }
y Colleen Demers
Commission No. (Seal)
Commission No.
q 5 SA1tEeOF'�FLORIDA
,_ Comm# GG18D453
'
19 Expires
12912022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
rev. a/c/ _�