HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date' Permit Number:
� -I is a_
Building Permit Application
Plahrring and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CommercialResidential 4-1_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the and of line
RR POSED IMPR .1IwM'ENT LOCATION:
Addr� ss:-ii�c. _
Lega Description:
Property Tax ID #: Lot Na.
Site Plan Name:
Project Name: Block No.
Setbacks Front Back: Right Side: _Left Left Side:
DETAILED DESCRIPTION OF WORK: '
"'Ak C'f� � Cmn C>-7 -5 ram./
CONSTRUCTION INFORMATION:
1. onal work to e e orme un er t is permit — c ec a app y:
�HVAC Gas Tank ❑Gas Piping J Shutters
Electric 0 Plumbing Sprinklers 11 Generator
Total $q. Ft of Construction:
Cost of Construction: $ �)
OWNE.RAESSEE:
5 Ft. of First Floor: _
Utilities: Sewer Eheptic
Name: N4-v-
Address:] S% �.,-trk' rF �,•,, _
City: ^ I - 0 f e Cr e State:f�11-
Zip Cgde: L[ 2 8 Fax.:
Phon� No.
E-Mail:
Fill in lee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:
Address: %
r
City: F • ,Carr,
Zip Code: 3 q j X
Phone No. � �
E-Mail: L c "
State or County License:
If valud of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Windows/Doors
Roof Roof pitch
Building Height:
PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
11UN K/tNGINEER: , Not Applicable MORTGAGE COMPANY: Not Applicable
7e• Name:
ress: Address:
State: City: State:
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 cerili-ify 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, conSL-it with lender or an attorney before
commencing work or recordingyour Notice of Commencement.
S' ture of Owner/ Lessee/Contractor as Agent for Owner Signature of contractor/License Holder
STATE OF FLORIDA ; STATE OF FLORIDA
COUNTY OF .. ( ,
COUNTY OF �) —�
The forgoing instru Sent was acknowledged before me The forgoing instrument was acknowledged before me
this ',3 day of --. L - 20� by this � day of C k 201-5 by
4
Name of person taking statement Name a person aking statement
Personally Known if OR Produced Identification Personally Known OR Produced Identification
Type of Identification
Produced Type of Identification
Produced
(Sig ature of Not P l - e o FlorW@f6yMARTIN
(Signature of Notary Publ
= ..
Comtrtission No.
?° • ,y 1�: Notary Public - State of Florida
_ o; Com # GG 346354
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My Comm. Expires Jun 18, 2023
Commission No.
n ►�' . MIKE RAY MARTEN
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?° • Nota State of Florida
oFtti.:•'
Bonded through National Notary Assn.
_ Corm = C,G 34fi354
'�ar rt° µy Comm. Expires Jun 13, 2023
Bonded through Natlonai Notary Assn.
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Rev. 8/