HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
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Date: Permit Number: I�y� �� /
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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: / h 1
Legal Description: rr '/ C(
5 l- / 9_q o? -C9 !
Property Tax ID#: 3�ay ' - ���� �' y 00-- 0 Lot No.�_
Site Plan Name: Block No. -IM—
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
4E iui, � o�N�N F611. vECwf r'
AW toft-,&V� 4A4 At
CONSTRUCTION INFORMATION:
Additional work toe e Orme under this permit-check a appy:
HVAC E]Gas Tank E]Gas Piping _Shutters t__.1 'ndows/Doors
0 Electric 0 Plumbing O Sprinklers 0 Generator _Roof Roof pitch
Total Sq. Ft of Construction: m Sq. Ft. of First Floor:
Cost of Construction:$ �J(/_ Utilities: L.
Septic Building Height:
OWNER/LESSEE: CONTRACTOR: n
Name Name: v
Address: _307-5- n Company: O -7
City: pal Sta _ Address: 1001SOS.
Zip Code: Fax: City: PSSState:-L-
Phone No. - Zip Code: 3�; Fa •777 33-q!�_�
E-Mail: Phone No. (7 7 L I 33 A_- 6f3V
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License: I -CC 623 cM2 3
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: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: 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 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 Commencemen
VSnatlure Owner/Lessee/Con ra r gent Owner Signature of Contra ctor/L nse Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF I COUNTY OFSJ-- &V G
The for ing instrument was acknowledge before me The forgoing instrument was acknowledged efore me
this y of 1h14_ ffI _ .20A by this day of mG(ff) 20 by
N /l & 'S. -4f, in
Name o rson making statement Name of perscyf making atement
Personally Known OR Produced Identification Personally Known tiV/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-//State,ofFlorida)
Commission No.ff-__ ,,) (Seal) Commission No. to D� (Seal)
P
_� Jen fifer Davis :��� Jennifer Dai is
REVIEWS My o � (�F 96 SUPE ISOR PLANS VEGET I�,"` ° ,°SBA TL1RTlfi) F [�P�GR E
C EREX�' eR _'.. c W REVIEW REVIE °or r. ALXVtEW� 9/2J REVIE
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17