HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Add ress:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR lWFIDVIT: 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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i natur of Owner/ Lessee/Contractor as Agent for Owner
Signa re Contractor/License Holder
STAT FLORIDA
STATE O ORIDA
COUNTY OF ` T
COUNTY OF F -LLCM—rG�
The forgoio�ng instrume was acknowledged before me
The f raging instru t was acknowledged before me
this1`day of by
this day of i 0k' by
C-'1..
Name of person making statement
ame of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of [den i i a '
Type of Ide1:tifi1Gati0Q
Produced
Produced
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orida
(Signature of Notary u � A
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )1`11 t 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) 462-1579 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPRO1�-tMENT LOCATION;
Address: esC�:" ��� 'i sr� P i C:tCt�- >i $
Legal Description: PC�,�) - 2- Pr- Tr 1 _ `s � v 1 fit '2 Z +r)0t lDa, i I YZri S rf-
4 C' 1 rCJ'._ l.r 2,1 Z2 03 "?�: =E FT TN t-f, -r I
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
W _ -
CONSTRUCTION INFORMATION:
Additional work to be
nertormed under this permit -check all that apply:
QHVAC L__l Gas Tank ❑Gas Piping Shutters a Windows/Doors
Fl Electric 5pPfumbin 05prinklers 1:1 Generator F]Roof Roof pitch
Total Sq. Ft of Construction: S�Ft.j of First Floor:
Cost of Construction: $ - �0cG> •O Utilities: L_ISewer aSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR.
Name UUW_Ucc1 a.,.r`n
-�Cal�v
Name:
Address: 1-
�� j 1tCE'
Company: I.i��i�l :Q-f£fv�C
Company:
City:
Zip Code: 3l4q��' Fax:
Phone No.1 _.
State:_
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7�( i
Address: �? �C 1 05tc- CLt�et-
City: i C� ��ltJxC State:
Zip Code: 7 Fax: 7�" ii'rZ
Phone No. 772- - 01
E-Mail: Gk
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: i Y)k\.C. CL �, A Q, h Pe,
State or County License: C_PC_ ►t lea C7'�3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.