HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
,I
Planning and Development Services Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: I,-JU ' M Q 1 ',V.
Legal Description: J-LV?A- krv— —I 1h i
Property Tax ID #: 09 1 `l"O Gr/ `/ --0 C) 0. _5
Site Plan Name:
Project Name: 1V (,U)`(� r
Setbacks Front_______ Back: Right Side: Left Side:
Lot No._ ;
Block No.
m-
-� � 3,S 7 Kw
.,,WI N LU �C errormea
HVAC Gas Tank
under this perms - c ec
❑Gas
a app y:
Electric Plumbing
Piping
_ Shutters
Q Windows/Doors
Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ f t3 UtilitiestSewer
S . Ft. of First Floor:
Septic
Building Height:
Address: Name: O��jmt-4r)n
Company:
City: t'6� {'� n r� f �l
State: _
Address: I V
Zip Code: Fax:-: City:
Phone No. State;,�Z�
Zip Code: - Fax:`�7Z ��7%�
E-Mail: n 164- Phone No.
Fill in fe simple Title Holder on next page ( if different E-Mail: r) QC L:�c:4 n�
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name: ame:11ICR/CM211MLLK: — Not Applicable
N
MORTGAGE COMPANY: Not Applicable
Address:
Name:
City: State:
Address:
City:
Zip: Phone
State:
Zip: Phone: '—
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: —
BONDING COMPANY: _Not Applicable
Address:
Name:
City:
Address:
ZIP 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, 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
com_ mencin ork orf�gcordinR your Notice Of Commencement
-•b•• �.�IeF/ Lessee/contractor as Agent for Owner
CT NTY OF
The forgoing instru ent was acknowledged before me
this 44 day of 20i � by
Contractor/License Holder
DATE OF FLORIDA
COUNTYOF_ 'f�i"
The forgoing instrument was acknowledged before me
this -W� day of 20 by
Name of person aking statement Name of perso making statement
Personally Known _�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced
�;� Produced
' �"6:
_�• M. CRAIO A. aR0 SMAN '' CRAIG A. OR,
MY COMMISSION FF990902 'i MY COMMISSION
(Signature of Notary Public- State • ' t ' q.
�► %rWallots gnatu a of Notary Public- State
Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR
DATE COUNTER REVIEW REVIEW
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Commission No. (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW