HomeMy WebLinkAboutBuilding Permit Application AI, 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 Ft 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
PROPQSED IMFROVENIENT LOCATION::
; .
Address: �2. � � � ��
Legal Description: r- �d cl e- 1 e_
Property Tax ID#: 'F�ISZZ_ 800- GCO-1'' COC) __�S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIaNhOF WORtC r
. F.a.. .. . - i. ... x.:.. .. ✓
X15 V. Nc c occu c
CONSTRl1CTIONihIN.FORMATION
Additional work to be nerrormedunder this permit-check all t=app y:
HVAC t_J Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
01 Electric F]Plumbing U Sprinkiers Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 9e0Q 0___0 Utilities: Sewer Septic Building Height:
I
'QWNER/i.ESSEE'" _ ' ' � CQNTRACTOR - : _
Name tr Name:
i
Address: � �- (nlE' . �GZrC Company: i t.d
City:'22+ . LUA5,Q State: et_- Address:
I
Zip Code: a4scla Fax: City: State.--Z
{hone No. Zip Code: '-t Fax:
E-Mail: Phone Na.
Fill in fee simple Title Halder on next page(if different E-Mail: S OKI
from the owner listed above) State or County License: c
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
U ?PL ME ITA cions " UG f (� I N AUU C?R 111AI[0-N4
..,.��..��3« '�';i4 ,Z , . •���U�,,t�� :��:, ��a.�',,a#:,�"�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE 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 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.
/m/)(*V;m I /A/X*V,4"
Signature;of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ] STATE OF FLORID � AA
COUNTY OF ( Q,�� COUNTY OF
The for Ding instrument was acknowle, JAyfore me The rgoing instru ent was acknowledgebefore me
thism day of 20 by this %day of 20 by
Name of person rpEfking statement Name of person m aking statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pmduced i Produced
Jo, Law i
j2Wn�atVcfNotary Public-S Florida) ( ' atue f Notary Public-Stat Florida)
Commi ) Commission No. l)
=o1pRY P(,e4� Notary Public State of Florida
Liza D'Mayfield o40 PVe Notary Public State of Florida
a fission FF 2a33s3 �: Liza D Mayfield
" Expires 07/31/2 19 o
REVIE ori SUPERVISOR PLANS °T Expires 07/ 1/2019 MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17