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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: y - / Permit Number: s 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: - Legal Description: Property Tax ID #: � 4 -0.�2- - - o.l 0 0 f _ Lot No. Site Plan Name: Block No. Project Mame: Setbacks Front Back: I Right Side: Left Side: 1;7— C_ C_ - �7 CONSTRUCTION INFORMATION: Additional work to He nart6rnipil f In pr f re nprmit—rFarfe nil t at ann v: HVAC U_ Gas Tank ❑Gas Piping Name: Company: c`?U -' �- l o-ri-°-►,c-�_; Address: S_ w c- City:; -s— C_ C_,z__ Zip Code: 3 4 � J- J Fax: U Shutters Phone No.� ." . `'I 0 Windows/Doors Electric F� Plumbing OSprinklers 11 Generator Roof Roof pitch Total Sq. Ft of Construction: C--0 0 Cost of Construction: $ _ '7 L[ ©o 5 Ft. of First Floor: _ Utilities: Sewer 0- Septic Building .Height: OWNER/LESSEE: CONTRACTOR: Name c`C.-{.. Address: / J -3 �, °'=-4 City: `� _� c State:.__ _ ZipCode: a-4 5 s'_:2 Fax: Phone No. L-24 2 3 -s- 7 Name: Company: c`?U -' �- l o-ri-°-►,c-�_; Address: S_ w c- City:; -s— C_ C_,z__ Zip Code: 3 4 � J- J Fax: _'.�,.--, a nC_ c- State: E -Mail: Phone No.� ." . `'I 0 Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail: L c �� C�`.� ( 4„0 ,r a, J L_r� L State or County license: C I- - values ur runsirucuon Is ;Pzauu or more, a HtLuKuLD Notice or commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER- ____, Nat Appltca#�le Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Not Applicable Name: ^' Address: City: State: Zip: Phone: 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 commencin work-- recording -your Notice of Commencement Signature of �Owne�rlLess�eelCont�ractor as Agent for Owner STATE OF FLORIDA COUNTY OF 55 The forgoing instrument was acknowledged before me this 1� day of f ,, s - 4 20 (� by Name of person king sta%ment - t Personally Known OR Produced Identifi ori Type of Identification n Produced nor ;.. 0 0 ry <, c' (Signature of Notary Pu ` - State of Florida ,73 �0 w „ Z W Commission No. (Seal) W -R w +, Zoo FA vm REVIEWS I FRONT IZONING COUNTER REVIEW DATE — COMPLETED Rev. $/2/17 Si nature of Contractor/License Holder STATE OF FLORIDA COUNTY OF -------------- The forgoing instrument was acknowledged before me this -a day of 205 by Name of person making statement Personally Known !l OR Produced Identificatio Type of Identification Produced - t L nr h V c < nor ;.. 0 (Signatu of Notary Public- Sta of Florida) <, c' i,7, G Commission No. 7(Seal) �0 w „ Z W V n SUPERVISOR I PLANS VEGETATION I SEA TURTLE MANGROVE REVIEW I REVIEW REVIEW REVIEW I REVIEW