HomeMy WebLinkAboutBuidling PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
6 Permit Number,
Date: '�[ao -•__- --
-�' 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 L"_� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATIQN:
Address:C� 1
Legal Description. f'. o(-\ d,
'Q A-\ 1>
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Property Tax ID #: "1��01 Lot No. ..
Site Plan Name: Block No..-.-..-.
Project Name:
Setbacks Front Back: Right Side: _ _.___ Left Side:
DETAILED DESCRIPTION OF WORK:
1o1L� f /
CONSTRUCTION INFORMATION:
Additiona or to be nertormed under t is permit - c eck ai apply:
F]Gas Q Windows/Doors
HVAC Gas Tank Piping _ Shutters
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction'. � Sq, Ft. of First Floor:
E
Cost of Construction: $ IlV `` Utilities Sewer Septic Building Height: _
SOW N ER/LESSEE: CONTRACTOR:
Name
Name:
Address: W - 3
Company: '� �^•
City: State:
Ad cess: --
rr
Zip Code: I Q ^^JJ i Fax:
Phone NO.(I:Clq I. 059k? -__
City: kNo -, State:
Zip Code:'Ygl _ Fax: - '
E -Mail:
Phone No.
E -Mail: 'vt + ,fS
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
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: J_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 Dome 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 weer/ Lessee/Co rdEtorasA&or Owner Signature of ntractor/Licens H Ider
STATE OF FLORIDA STATE OF FLORI
COUNTY OF c �PsVf \ '��}Q L COUNTY OF 2� ?� JUL
The f Ding instrument was a knowledged before me The for ,ging instcu nt was a�(knowEedged�efore me
this ay of � �� 20_ I� by this day c ��lf1 20_1'1 by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known . OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatur of N Nary Public Staten aoriria �Ziamatu f PAtary Public -State of Florida )
Commission Q403 f P&(_-) , tit15" ,, JOYCE MMLO-CAMO aR `° .` JOYCE MICHAU&CARLC
16 W COMMISSION # GG 284220 MY COMMMSION # GG 2843
_ ,•+ EXPIRES, AM 25, 2022 PEXPIRES, April 25.2o22
f 1 Bw1deC7hu Nol�yp�la > a f41 OMM nN NoWyr Unclem
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION I
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17