HomeMy WebLinkAboutBuilding PermitALL APPLI SLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ► Permit Number:
--;yn 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
1 PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: tLA.L
Property Tax ID #: 1 .JE_t"► "
Lot No,
Site Plan Name:
Block No.
Project Name,
Setbacks Front Back: Right Side: _ Left Side:
DETAILED DESCRIPTION OF WORK:
a
CONSTRUCTION INFORMATION:
`Additional,work
to be efformed under this perms —check a appy:
VAC Gas Tank Gas Piping Shutters
Windows/Doors
11 Electric Plumbing Sprinklers Generator
Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $' �.D Utilities:l Sewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company:
Address; VrAjc> ;`�►
City: State:
Ad re s:
47 At
City: V0
h State:
�T
Zip Code: Fax:
Phone No.—► • "��
Zip Code. b
Zip
Faxx� -z
E -Mail:
Phone o.4- IICS'
E -Mail: ,II I
i�N�E(.� L
_
Fill in fee simple Title Holder on next page ( if different
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address:
City-
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:_
Address:
City:_
Zip:
Phone:.
Not Applicable I MORTGAGE COMPANY:
Name:___
Address: _
State: City:
Zip: Phone:
Not Applicable
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:,_
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 your Notice of Commencement.
Signature of wner/ Lessee/Co/
essee/Co r for as A &or Owner Signature of ntractor/Licens H Ider
STATE OF FLORIna STATE OF FLORIQA
COUNTY OF COUNTY OF �'% Lf %r\ F�
The for ping instru ent as acknowledged_ before me The f ing instru entwas acknowledg efore me
this day of jj(J 20.1 by thisomday of �Y _—, 20 by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signatur'Oof Natary Public- Stata o-?"Floriria 1
Commission 4.. (��t o;lib
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Name of person making statement
Personally Known _1,:!f'OR Produced Identification
Type of Identification
Produced
:�Ca .1
Kianatuh4 Ottary Public -State of Florida )
JOYCE MICHAUD-MO , ,;. JOYCE MICHAUD- A O
W C01MI8 MOW 284220 c+ MY COMMISSION 0 GG 284220
EXPIRE$, AprN 25. 2022
e. EXPIRES, April 25, M2
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SUPERVISOR PLANS VEGETATION I
REVIEW REVIEW REVIEW M