HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCE
•
Date- Permit '
A.
-_ MAY I2019
Building Permit Applica i��.mittir�� Department Planning and Development Services e p a rtm e n t
Building and Code Regulation Division St. LUcie C®Ulityr FL
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 IMPRO�/EM;ENT LOCATION:
r...
Address:
Legal Description:
Property Tax ID#: 0 00 U L/7 p 0 0 Lot No. Z.3
Site Plan Name: 93 l-tia j eAc_-e Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK E
Y'
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6
CONSTRUCTION INFORMATION
Additional work to be nertormed un ert is permit-c ec a appy.
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ L S�Z� Utilities: Sewer Septic Building Height:
OWNER/LESSEE `� = -_ CONTRACTOR fi
Name ff�� Name: _s
r-44
Address: /46--) dot Company: (_Of
City: LC Stater Address:,,3T 63 f
Zip Code:,3`[9,S 7 Fax: City: Sf z C t 1- State:-F—(--
Phone No. J qL_ 2_(o L Zip Code: 134 cliq Fax:
E-Mail: Phone No. Irl L -X 51 - Z
Fill in fee simple Title Holder on next page(if different E-Mail: f f
from the Owner listed above) State or County License:.Scc_ Z,; ,g6 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN`LA11U INFORMATIQN
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: r Not Applicable BONDING COMPANY: ANot 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,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 Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI STATE OF FLORID
COUNTY OF COUNTY OF r >Li'j^
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_7 day of v 201 by this day of Hrwr.� 20 by
Name of persorpffiaking statement Name of personuking statement
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Prod ced Produced
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",•�,•• X*EPII W09A :a MY C. M 'SSION 2T
(Signa ure {it (Sign u F -
`' s... Bo�deA?AroNdsry
Commission 4,ea Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17