HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: 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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 6oW P,�O �Btes . LUG. f >°l C'RCe Z FL 3 y gS/
Legal Description: KeW60d 10"K " Ulv ,-r q"' S LOZ'-S I o A-tic)
Property Tax ID#: (3 (9 I 6 It-o3o-i-oo Lot No. 10 b-11
Site Plan Name: Block No. S
Project Name: We-WA
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Al e.uJ Co NCk'e7'�e- N i llaWAY PROM 6hRtl W 7'0 200,
Cu LVe-y tgeQu11e64 3uRi eb 1)/WdAC-C SYSTe,-
M nJtM V_e0 R Y ccV.1111-y
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CONSTRUCTION INFORMATION:
ACICUtional work to be nertormed under this permit-check all apply:
I -F]HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
LIElectric 0 Plumbing OSprinklers F]Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ -Li 0 00 . DO Utilities: Sewer El Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name e-4, 9- TPW 7uRNep Name:
Address: WoLl 10ko Rlosids Btu() Company:
City: f:3&T. P rtfi ce . State: FL Address:
Zip Code: 34 qS1 Fax: City: State:
Phone No. 77 2- L/IW - 6V q S_ Zip Code: Fax:
E-Mail: ATl UkNeR It (9 6:1MCAsr-.1ve7 Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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: 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.
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Signature of Owner/Lessee/Contractor as AgentU Owner Signature of Contractor/License Holder
.STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -� � +�4o COUNTY OF
'The f rgoing instr ent was acknowledg before me The forgoing instrument was acknowledged before me
this 7-• day of 20 by this day of 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 Identification
; Produced Produced
(S at®ref Notary P r��• e o . ING BANNING Aure of Notary Public-State of Florida)
MYCOjAMIS$ION#GG 275060
Commission No. cember'20,2022 Commission No. (Seal)
'yr�oFF;QQ' BondwTtuu Notary public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17