HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: " / Permit Number:
KiKel lion
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,
Address: C� c stC Cc
Legal Description:
Property Tax ID #: ( -2- .'�> Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
'DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Right Side: Left Side:
Addi -onal work to e e orme un
f]
er this permit - check
a app y:
In
HVAC Gas Tank
❑Gas Piping
Shutters
Q Windows/Doors
_ Electric 0 Plumbing
Sprinklers
E Generator
0 Roof Roof pitch
Total Sq. Ft of Construction: %L,l
S . Ft. of First Floor:
Cost of Construction: $
-Lq za Utilities: Sewer E]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name • C
Address: It e) o Q-- SC� �-_...-.,
Name: �
Company: CCID 0
City: ` State: L
Zip Code: j `} Fax:
Phone No.Ji-, f '� S
Address: i `{
City`- — State: r�
Zip Code: 3 Fax:
Phone No.�-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: c
State or County License: C_
IT value or construction is :yLWU or more, a i LCUROLD Notice of commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN Leif 1
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
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 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.
ntractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S r L
The forgoing instrument was acknowledged before me
this ac^2day of 20�' by
Name of person making statement
Personally Known c. — OR Produced Identification
Type of Identification
Produced
� G
(Signature of Notary Public- State of Florida )
Commissi N -_4k TAYI OR GAG a
a° Notary Public -State of Florida
y o` Commission # GG 293167
My Comrnscion Expires
Signature of Contractor/License Holder
STATE OF FLORIDA—
COUNTY
OF
The forgoing instrument was acknowledged before me
this _ � day of r 20 i by
Name of person making statement
Personally Known
�= - R produced Identification
Type of Identification
Produced
(Signature of Nota
P i ,� a
Commission No.
Y"L`'JAYLOR GAGNE
Notary Public- tat of Florida
_' •; Commission
293167
FF,� Y Commission Ex
January
21, 2Q2,3
ntv�cws - FR[71v7� °' PERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17