HomeMy WebLinkAboutventure A3ALL APPLICABLE INFO cMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / / Permit Number:
w
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: /61 7 S/ S, CSC '-4 i/J L o 113
Legal Description: �/S / / 3 / j Cl c.i 7 C/
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
FD_
_ETAILED DESCRIPTION OF WORK:
s
4,1 / I -75
-.1
CONSTRUCTION INFORMATION:
Additional work to brtormed under this permit —check all appy:
a e
HVAC � Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ '2'&(' C
Sq. Ft. of First Floor:
Utilities:Sewer OSeptic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name ;A1c r ,,7 6yi to
Name:
Address: %G' %S i S ; oc OIL A - J y
Company:
Address:
City: State:
Zip Code: Fax:
Phone No.
City: c --71-e— I'l r,,I State: 41rI
Zip Code: 21t `%� 7 Fax:
Phone No. 7 1 73.2—
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail:
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
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
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.
Signatuie of Owner/ Lessee/Contractor as Agent for Owner Signature of, ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me I The forgoing instrument was acknowledged before me
this I day of�,o. , / 20 by this J day of /y�r ._l 20� 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 Identifications
Produced Produced
(Signature' Notary Public- State o of Notary Public- State of Florida )
ti►P v " -
RACHEL DAVIS
Commission No 4 _°1► MY COMMISSIO No. '.
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
EXPIRES Janu$ry 5, 2019
798-0157
ZONING SUPERVISOR I PLANS I VEGETATION
REVIEW REVIEW REVIEW REVIEW
REVIEW
RACHEL M DA1
My COMMISSION #FF1
EXI�IRES January 5,