HomeMy WebLinkAbout1523_001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 311( "1 Permit Number:
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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: Y `Vl�•L
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Property Tax ID #;
Lot No.
Site Plan Name:
Block No. l
Project Name: 4(t
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
,nom..<460
`
CONSTRUCTION INFORMATION:
Add ffiq90 work to e pertormed under t isperms — check all appy:
HVAC Gas Tank E]Gas Piping_ Shutters
Windows/Doors
11 Electric Plumbing Sprinklers El Generator
E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ `C � Utilities:[] Sewer Septic
Building Height:
OWNER/LESSEE: CONTRACTOR:
Name f\Z 4 Name:
Addr ss. Company:�Il�`w
City: ,) State.
-PlAddress:
Zip Coder Fax: Cit '
State:
%—C7A
Phone No. Zip Code.
Fax:
E -Mail;_ _ Phone No7
Fill in fee simple Title Holder on next page ( if different E -Mail:
ll1
from the Owner listed above) State or County icense:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:_
Address: _
Address:
City: State:
City: State:
Zip: Phone
Zip: mm Phone:
BONDING COMPANY: Not Applicable
FEE SIMPLE TITLE HOLDER: _ 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.
Signature of wrier/ Lessee/Ca r for as A en or Owner Signature of ntractor/Licens H Ider
STATE OF FLORIna STATE OF FLORI
COUNTY OF j�'ipi1\ ��]UL COUNTY OF �C�
The fo going instco ent was a k owled Q before me The v raoing ins nt was cknowledg�before me
this day of 201by this day of �i N!� 2Q by
Name of person making statement Name of person making statement
Personally Known s,-"- OR Produced Identification Personally Known" OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatur of N tart' Public- Staten loriria I I KianAtu l` LL tary Public- State of Florida )
Commission . • ��V ' • JOYCE MICFIAUDd;ARLO . y ?{SL'•'"•' JOYCE MICHAUD-CARLC
#� MY OMINION ISI G0 284220 =ION 0 GG 284',
EXPIRES: Apr l 26, 2022 : Y; F-XPIRES; April 25. 2022
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$mow Thu Notary PLf* � „ Ba1daQ Pin PU* MWIN"
REVIEWS FRONT ZONING SUPERVISOR PLANS I VEGETATION I
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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