HomeMy WebLinkAboutbuilding permitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 _ 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
PROPOSED IMPROVEMENT LOCATION:
Address:
CC
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Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: YtA_, a -�> _ Block No.
Project Name --
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Ac "I V O(A_
CONSTRUCTION INFORMATION:
Itl a wor c o e e orme underthis perms — check all tbat app v: - —
HVAC ❑ Gas Tank Gas Piping
11 Electric ❑ Plumbing Sprinklers
Total Sq. Ft of Construction;
Cost of Construction: $
L_J Shutters ❑ Windows/Doors
Generator ❑ Roof Roof pitch
S Ft. of First Floor: _
Utilities:Ct Sewer 11 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 4 ISO.Name:
i'
Address: N —L y�
City: r` State: C L
Zip Code. Fax:
'
Phone No.
Company;
Ad ress: —
ze
City: i7
rrA,
Zip Code: Ale _� Fax:
Phone N .
E - Mail: 1 a. A%OJA
State:
i
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: Not Applicable4MORTGAGE COMPANY:
Name: Name: _
Address: Address: _
City: State: City:
Zip: - Phone , Zip: Phone. -
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
City:_ -
Zip:
Phone:
Not Applicable
State:
Not Applicable
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 representatlon 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 deers 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 wner/ Lessee/Cot
essee/Co r for as A en or Owner
STATE OF FLORID
COUNTY OF
The f r ❑ing instru nt was acknowledged efore me
this .dayofT� z� [ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
9/0&,)r -
Signature of ntractor/Licen AIder
STATE OF FLORI
COUNTY OF��', �
The fqjgoing instr. t was acknowledg j1efore me
this day of ZQ,_ by
Name of person making statement
Personally Known CIR Produced Identification
Type of Identification
Produced
(Signaturl�of Notary Publicc--lSjtate n_f`Floriria 1 I ifiAnatukQf ittary Public -State of Florida) II
Commission tf.,0 1 p�p1�[�! "� JQYi�iiCHpUO.•p .� .•'t'S JOY(EAli�idAllC)CJIp
•' *. # 002&3220 *, UY041i ISSloNit00284220
MORE$: All 2S.2022 � P= IXPIRES: April 25, 2022
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION I
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE - -
RECEIVED
DATE
COMPLETED
Rev.8/2/17