HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETEM'OR APPLICATION TO,BE ACCEPTED-
Date: Permit Number: Ut
�, Building Permit Application
Pldnning and Development Services
Building and CodeRegulation Division
2300 Virginia Avenue,Fort Pierce FL-34982
Phone: (772)462-1553 Fax: (772)4624578- Commercial Residential _ _
PERMIT APPLICATION FOR: ,TO.Selectfrom dropbox,.click arrowWat the end-of line
PROPOSED IMPROVEMENT LOCATION
Address:
Legal Description: "
Property Tax ID#: 131 a 10 I ' C)- f L/-600-, Lot No.
Site Plan Name: Block No... .
Project-Name:
Setbacks Front Back: Right Side: Left.Side:
DETAILED DES.CRIPT:ION OF WORK,
LY
CQNSTRUCTIO'N INFORMATION
.:
Additional work toe e orme under this permit-check a appy:
HVAC [,Gas Tank; ❑Gas Piping _Shutters a 1Nindows/Doors
Electric Plumbing ;Sprinkler"s Generator Roof .: Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:S �( Utilities:Sewer Septic Building Height:
01NNER%LESSEE C NIRA .`
g ? !
0, CT'OR
Name AcA - Lt Name: Cn"e—
Address�' -7-'x"8'. 'eb Company ,t [n
City `I ,.:rte. '" State: l, Address D� 41&7 AV
•
ftp Code -� Fax: City i ^t
State:-a,..
�qj° Zip Code. c�' Fax: / �0
?.
E-Mail: Phone No. -CS 0 o
Fill in fee simple Title Holder'on next page(if different E-Mail: ,RA T ;
from the-Owner listed above) __ . State or County License: -.3.00 5� `
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLfEMENTAL CONSTRUCTfON LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not-Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: PhoneZip: 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 mayapply.•
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 Commencerrient'may result in your paying twice for
improvements to-your property.A Notice of Commencement must-4e recorded.and-posted on.the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commeUing work or recordAig yourrecord' Notice of Commencement:
Signature of Owner/Lesse /Contractor as Agent for Owner Signature of.Contra ctor/Lic nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OFAs-
The forgoing instr of as acknowledged before me The forgoing instru e t was acknowledg +before me
this day of 20_ by this`��day of 20 1 by
Name of'.person making statement Name of person making statement
Personally Known 3 OR Produced Identification Personally.Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
gAat re of Notary Public-Stat of Florida►: n; ure of Notar
`{�iy Public-St to of Florida
Commission No., (Seal,) Commission No. (Seal)
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G( REVIEW REVIEW RE�t
DATE t
RECEIVED -
DATE.
COMPLETED.
Rev.8/2/17
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