HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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
Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: A Q
Legal Description: ;,. L� Lc- 6
Property Tax I D #: .1 371 e ' I f 0 0 -) . C) _- C7 'O
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
/2- SC-
C -,6,7 _ ';
CONSTRUCTION INFORMATION:
Itiona VV FR to e e Orme un er this permit- cliil::!,Ea11Iappy:
SHVAC Gas Tank ®Gas Piping_ Shutters Windows/Doors
Electric Plumbing OSprinklers I Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ `/ 6-D Utilities. Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Lz S
Address:/ S- �-/` ® L G
City: v, ,L State:
Zip Code: 9-2- L l �Fax:
Phone No. ^
E -Mail:
Fill in fee simple Title Holder on neat page ( if different
from the Owner listed above)
Name:c ; c
Company: LD �QSr 1`1101�1
Address: S-
City: 10.-; 9�1 L G; _...., State: 1= C—
Zip ode: —7 (/ C Fax: _
Phone Na. dG 3J—
E -Mail• p C
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
utbIUMER/IENGINEER: Not Applicable
Name:
Address:
City: State:
ZIP: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
city:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: '"tate:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip:_ _ Phone:
Not Applicable
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 recordingyour Notice of Commencement_
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrummW was acknowledged before me
this 44 day of� 20V# by
Name of pe sn temen
Personally Known OR Prod fi
Type of Identification �. '' ; Nor-
Produced:srary �$uc
PPI9Z5 8
11
(Signature of Notary Public- State of Florlaa l
Commission No. 2V_ (Seal)
Holder
STATE OF FLORIDA ��
COUNTY OF
The f0going instru-Mrpt was acknowledged before me
this day of 20'
Name of person maki nt
Personally Known OR Produced Identification
Type of Identification
Produced
r Heather Tro
4(ignature of Notary Public- State of
r STATE Of- FLOR]
Commission No. -` I�Com"*FF192528
Expires 1/25120
REVIEWS I FRONT I ZONING SUPERVISOR PLANS VEGETATION I SEA TURTLE MANGROVE
ATL I
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW I REVIEW
RECEIVED
DATE
COMPLETED
Rev. $/2/17