HomeMy WebLinkAboutBuilding Permit ApplicationLLL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:L3 1 Permit Number:
EO
Building Permit Application
ing and Development Services
ng and Code Regulation Division mept
Virginia Avenue, Fort Pierce FL 34982 3r Q G e�"IL
e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P#ROPOSED EIMPROVEME,NT,LOCATION':
Description: l�i)Vtot_ ttl
)erty Tax ID #: 1, _�2 IC l 0 Uc
Plan Name:
act Name:
Jacks Front Back:
W W
Right Side: Left Side:
JHVAC Gas Tank El'
Piping _
rr•�-
Shutters
11 Electric 0 Plumbing
Sprinklers E
Generator
tal Sq. Ft of Construction: —7
st of Construction: $ /
S Ft. of First Floor: _
Utilities:nSewer Septic
5 Lo+ 5
Lot No.
Block No.
Windows/Doors
Roof Roof pitch
Building Height:
OWNER/LESSEE
Name
Address: S)A-n
Name:
Company:
City: I c¢ State-�B-
Address: 141 A 7S 19q 3
,IZip Code 1 cr7 Fax:
City: State: 12�_
Phone No.
Zip Code: ---39 271 Fax:
E-Mail:
Phone No. --3QI - o(D �,�'�
Fill in fee simple Title Holder on next page ( if different
,-"a,L�3
E-Mail: l)ISY�c.CI �It en+:T— n
I the Owner listed above)
State or County License: (f eIC
11 vdlue Of conszrucaon is azwu or more, a KtcuKutD rvotice of Commencement is required.
i
:SUPPLEMENTAL CONSTRUCTION LIEN L4tW INFORII/IQTION
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY. Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: s Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
dWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I lcertlfy 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.
+he 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 resu 'n your paying twice for
improvements toy r roperty. otice of Commencement must be recorde an poste the jobsite
before first ins 'th
the ect on. If u in end to obtain financing, consu le n r o an ! me before
commencingwor or r cor 'n ou Notice of Commencement.
. I y L."/ "�
-
I / I V
Signature of O er/ Lessee/Contractor a Age t for Owner
r ctor/License der
Signature of ConI)RIDA
STATE OF F ORIDA
STATE OF FL
U_
COUNTY O I eca 442
COUNTY OF c�
The for oing in rument was acknowledged before me
da
The for oing ' str ent was acknowledg efore me
this O 20g by
this da of Y 20 by
Name of person making statement
Name of person making statement
Personally Known v— OR Produced Ident" c ion
Personally Known ^), OR Produced Identificati
Type of Identification
Type of Identification
Produced
Produced
ZA
{,
-1
( ignature of N ary Public- Sta a of F
Signature of Nota Ivc- S a f r
Commission O oO P%_ Notary Public StatefS�f��rida
iccabon
COmm15510 Y ��°4 Notary Public State of F,1 rida `
NP aboni �eal
My Commission FF 981647
rt+�oiAp&A
yr_ c` My Commission FF 981647
�/�OF�pP
Expires0512812020
Expires05/2812020
REVIEWS-
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17'