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)4621578 Commercial__ Residential
f PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: I!!
Address:
Legal Description:
PropertyraxlD#:Lot No.
Site Plan Name: /1 Block No.
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Project Name: a0fvf IS GCif1L(G l�Yll VI
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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I CONSTRUCTION INFORMATION: III
AGas
Tank ❑Gas
Plumbing
Piping
Sprinklers
IJ Shutters a Windows/Doors
1:1 Generator 0 Roof = Roof pitch
11
Total Sq. Ft of Construction:
Cost of Construction. $ 4 aQ o. Qo
SQ. Ft. of First Floor: _
Utilities Sewer E]Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name i
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Name:
Address: Cj0 ( w 315r kytai
Company:
it I VBG
City: VO Q State:
Zip Code: 223���3�0i0C1 Fax:
Phone No.1ui (L('S WA. 215-Ivo-Ct`inl (�"2i'U
Address: SIU IUM IvQ E( w•
City: _�t 1�(ru2 State, Ri
zip Code: 3066 Fax: i lo�'�($�p-373Tl
Phone No. 712-' TCP 1-1 141
E -Mail:
FB in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail:
611 P-0.0,0- \ fad
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State or Co my License: Ctkbl 1212
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 Count, 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 your Notice of Commencement.
Rev. 8/2/17
Signature of Contractor/License Holder
Signature of Owner/ lessee/Com ra or as A enfj3!r Owner
STATE OF FLORIDA C' r
STATE OF FLORIDA C�
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
this l$�"dayofPbfUgft� 20 WI by
The forgoing instruyent was acknowledged before me
this 314-- Ytbr 2011 by
Ma' a
M,Udwr-. 60gfe�
Name of pens m king statement
Name of pers making stat ment
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sign b'c t�i"
(Signature Ii '5 to of Florida)
.•.`°v.....,, CHRISTINE J. CONWE�L
Com ic.�.State Ale
`�'iri�°6'Ge�,, CHRISTINE J. CO Q )
Commissio n
of
ILC - S[ate of i FloFida
- Commission # GG 017839
gs '. Commission # GG 017839
%x;,,� ,' My Comm. Expires Aug 21, 2020
••„ sw �°.' MY Comm. Expires Aug21 . 209n
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;lona otary Assn.
rough Nalional Notary
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REVIEWS FR
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PLANS
VEGETATION
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COUNTER
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17