HomeMy WebLinkAboutBuilding Permit ALL APPLICA LEI FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I 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 0CATION:
Address:
Legal Description:
Property Tax ID#: • CAM Lot No.-icl2n
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
3tio ork to bewerformed un ertf!
fiTsperm�t—c ecc)—aif rShutters
Gas Tank Gas Piping Windows/Doors
Electric Plumbing Sprinklers L Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ `
Utilities., Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Ai
Name Name:
Address: _ Company:
City: Gam- State. i , -- Acl ress:
Zip Code: 5 Fax: City: �c c �(� Stater
Phone Norma • Zip Code: . Faxki"
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail: iiftVi S• vR�
from the Owner listed above) State or County License: 9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL "CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER»_ _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: I Name:
Address: Address: _
City: State: T City: State: v
Zip: Phone Zip; Phone;
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
i Address: _ J 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
commencinE work or recording our Notice of Commencement.
- �&a--/AP a 16 UA-
Signature of weer/Lessee/Ca r for as A en or Owner Signatu4ofnt4racttr/PLC_icens H Ider
STATE OF FLORIDA, STATE OF FLORIEIA
COUNTY OF COUNTY OF
The forgoing instruiaent was acknowledge before me The Forgoing instL t as acknowledge before me
this day of 20f4 by this day of � TO,�i by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known_4=:f�011 Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatur of N tary Public-Staten I r'ria 1 , tary Public-State of Florida )
JOYCE MICHAUD
Commission t e !. MY COMMISSION#GG1 ° car ..
4Q EXPIRES:April 25,2022 y . JOYCE MICHAUD
Bonded Thry NoWy Pubric Undwwft n ;rq. I
— =.- MY COMMISSION#GG 18
: : Y= Pi 2tl
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ., ll
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17