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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application Plodnfng and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) asz-153 Fax: (��z) 4i;z-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PRgPOSED IMPROVEMENT LOCATION: Address:� , Legal,Description: Property Tax ID #: )3 Y - Quo Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: �+ i 0 6L iTRUCTION INF3RMATION: ona I work to aer orme un er t is permit - check a HVAC Gas Tank Gas Piping Electric © Plumbing Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ 3 OWNER/LESSEE: apply: Lot No. Block No. LA-' r Shutters FlWindows/Doors Generator 0— Roof Roof pitch S . Ft. of First Floor: _ Utilities:Sewer Eheptic Haaress: `L City: J � ' , p ,� f P State: F:74 Zip Code: Fax PhoneNo. _ c 1`7 1 E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Name: e r__ Company: Address: 7 �5_ City: • t'r t Building Height: hJC-,(- Zip Code: c7 `6 cpk Fax: i Phone No. - 4 (,a q - "37 3(, S E -Mail: L413 0 ', " 1,J Yn LJ Jo State or County License: CA C i -r1 -5c If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. _7 J 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: PhonL_ re: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. 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 recordin your Notice of Commencement. il�� N_ signl re of Owner7 Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA/ STATE OF FLORIDA , COUNTY OF -.4 � r COUNTY OF '�J - The forgoing instrument wal acknowledged before me The forgoing instrument was knowledged before me this•`' day of 20 1"1 by this day of ^ `. Zp-LcL by Nam of person mg statement Name arson making statement Persdnally Known Y� OR Produced Identification Personally Known 12:� OR Produced Identification Typeiof Identification Type of Identification Produced Produced (signature of Notary Pu is o,SS$M,9f Florida ) MIKE MARTIN Signature of Notary Pubic to pJ;,§9rida j MIKE MARTIN Commission No. 14 «�? Notary Public - State of Florida _• : : • t�5m)ssion FF 21695t ommission No. it°. `�� • : • Notary Public - State of F {S�pjnlsslon FF 216E '17-11My Comm. Expires Apr 5.20tg '•� %,, °: �'` My Comm. Expires Apr 5, ��" Bonded through National Notary Ass °F F`• ,l 1, l l�� Bonded through National Notar REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED I_COMPLETED Rev. 8/2/17