HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAf3LE I 'FO 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)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �0 ( ( V n S ��(T� T� taC�
Legal Description: 01��,� l '�, �� aes y (+ p�q
Property Tax ID M. 2246 `Joe- b--3 b=(odQ — LO Lot No. Q
Site Plan Name: Block No.
;Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUcl
CTION INFORMATION. _ n
Additional work tonGasTank
orme under tispermit-check as appy:
HVAC ❑Gas Piping _Shutters Windows Doors
Electric Plumbing Sprinklers E Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ J � V Utilities: 0Sewer OSeptic Building Height:
::OWNERJLESSEE: CONTRACTOR:
Name Name:
Address Q20 -F)eVr Company:
City: (�(�` �"� �U�� Stater Address: I U�I l
Zip Code: DH q�j Fax: City: p���C State:
Phone No.2pb�s E—,pE 4q Uq Zip Code:�3aQ LOO Fax:
E-Mail: Phone No. q "
Fill in fee simple Title Holder on next page(if different E-Mail: S
from the Owner listed above) State or County Lic -715-7 LJ
— COMP-1 30
If value of construction is$2500 or more,a RECORDED Notice of CommbficemeYit 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,fence's,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 Notic_ . ommence ent.
z il �
Si ature of Owner/Lessee/Contractor as Agent for Owner -gnSJ a&�o Contractor/ -cense Holder
STATE OFTLORIDA STATE OF FLORIDA q art_
� } �
COUNTY OF !'�11an YLt ka- COUNTY OF IU�j
The forgoing instrument was ac nowledge before me The for oing instrument was cknowledged before me
thi !L day ofC 20 by fihis day of (( �. ,20 by
'bAN -TU n.�i2__ i'•1 +' I L t t4-IYE lZ
Name of pers n making statement Name of person making statement
Personally Known OR Produced Identification Personally Known l/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Not Public-State oiiad ature ota P lic-State ao$Florida)
�o �. ..fic KELLY L.MONEY"A ao,.••-=,r% KELLY L.MONEYHAN
Commission No. Ankeaby COMMISSION#FF 90 5tommission No. itISSION#FF 903559
EXPIRES:July 26,201 ENCE July 26,2019
OFfloBonded Dru Budget Notary Sery esOFfl� Bonded Thru Budget Notary Services
REVIEWS, FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17