HomeMy WebLinkAboutBuilding Permit ApplicaitonALL APPLIC BLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ESx
v 4.- Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
•2300 Virginia Avenue, Fort Pierce FL 34982 .-
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial lam' Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: -
Legal Des iption.
a n 6X qla, a- t A C 60om U+
Property Tax ID #: Zql_V - ' V . rLU
669
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
(C cx/� f
'� I V0
Lot No,
Block No.
CONSTRUCTION INFORMATION:
Addition or to e e orme under this permit - check a apply:
HVAC Gas Tank ❑Gas Piping Shutters
11 Windows/Doors
11 Electric Plumbing Sprinklers 12 Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 11 Utilities: Sewer a Septic
F OWNERAESSEE: J i CONTRACTOR:
Name 11 4 Name. 41
Address:wb L L2 it -OL Company: �
City: r 1 State:- Address:
Zip Code:Fax: City: \(> a
Phone No. L491� Zip Code: G 6
E -Mail: Phone N
Fill in fee simple Title Holder on next page ( if different `, E-Mail:4'1
from the Owner listed above) i State or County License: _
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Building Height:
S.
SUPPLEMENTALICONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
Name;_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address;
City:.
Zip: Phone:
State
Not Applicable
MORTGAGE COMPANY
Name:_
Address:
City:
Zip: __ . Phone:
_ Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:___
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 financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
F
Signature of wner/ Lessee/Co r for as A en or Owner Signature of ntractor/Licens Hider
STATE OF FLORID T STATE OF FLORIgA
COUNTY OF , COUNTY OF
The f rRoing instau ent was acknowledged before me The r going insttum nr was acknowledge efore me
this . day of d 1 20_t by this' day of � ) _ , ZO_1�by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State
Commission PgG i M 43
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Name of person making statement
Personally Known 1J�OR Produced Identification
Type of Identification
Produced
atary Public -Stag of Florida )
JOYCE MICHAUD i
MY COMMISSION: GG'fa34°
EXPIRES: April 25, 2022
r Bonded Thru Notary Public Undenp tme
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
JOYCE MICHAUD
MY COMMISSION # GG 1