HomeMy WebLinkAboutBuilding Permit ApplicationALL #PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Da4 Permit Number:
Building Permit Application
Planhing and Development Services
Building and Code Regulation Division
2306 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PE6AIT APPLICATION FOR. To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: -
kddre.�s: LA j Y,
Legal escription:
Prope ly Tax ID #: L4 3- — 000 Ll — 000 `- `7 Lot No.
Site Plan Name: Block No.
Proje Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INN 9RMATION:
itiona workto a :e `orme under this permit —check all apply:
�HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
13:Electric 0 Plumbing []Sprinklers Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: 5 . Ft, of First Floor:
Cost of Construction: $ ,Z�� Utilities: Sewer Septic Building Height:
i
L
CONTRACTOR:
Name° — :, a 'n
Name: /.
r n on
Address: U i v,- 9
Company: i.n9v ', r
ion ,.
City: i :c State:
Address: ®C-,
c.�-cc
Zip Cgde: Fax:
City:- re-,,
State: 19��
Phone No.
zip Code: 5 Ll 9 &a. Fax: G(Co Ll l l o-) -2
E-Mail•
Phone No. L �oL _ fS S
FIII in fee simple Title Molder on next page ( if different
E-Mail: J i, r e6 CL
4 1,.1 '
from jhe Owner listed above)
3
State or County License: CAC
(5f (368'I
IT Value or construction is.5zsuo or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
i
Zip: Phone:
FEE tIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
_
Name:
Name:
Address:
Address:
City:
Zip: I Phone:
City:
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, wails, 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 vour Notice of Commencement.
Signa, re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF - -
STATE OF FLORIDA �
COUNTY OF_ 54 — X/
The frgoing instrument was acknowledged before me
_5w
The forgoing instrument was acknowledged before me
this day of 20j_'�, by
this day of 5�.•`tr ! 20by
Name of person making statement
Personally Known OR Produced
Name of person making statement
Personally
Identification
Known OR Produced Identification
Type!of Identification
Type of Identification
Produced
Produced
e
(Signature of Notary P '
(Signature of Notary Public- a. • . onda MIKE RAY MARTIN
`oti� MIKE RAY MARTIN
Comrission No. =t: ,y «� :. Notary P $I State of Florida
_--
r° ~��` t+otary public - State of Florida
Commission No. sFon X GG 146354
UV o: Commission # GG 346354
arfl°E` My Comm. Expires Jun 18, 2023
oc Mr srmm, Expires Jun 08 2023
3or.ceC through National Notary Assn.
Bonded through National Notary Assn.
RE
IEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. S/2/17