HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ /� s l Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential r�'f
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: G „2 �::z O —[ y L---` C. C- -rZ -
Legal Description:` i` C Sr "r
Property Tax ID #: 1440�4- - C)&-i1 -- 1200 - .z- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
7a
G t� /4�/c c s
CONSTRUCTION INFORMATION:
itiona work to a rme bn ert is permit-c ec a Japply:
FiVAC
FIGas Tank Gas Piping _ Shutters Windows/Doors
_ Electric 0 Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: _
Utilities Sewer 0 Septic
Building Height:
OW N E. R/LESSEE:
CONTRACTOR:
Name e_:
Name: �_ m
Address
Company:
City: Sc_ Z:) _ State: i�L
Address:
4 '�--
Zip Code: �,4 SJ , Fax:
City: �D .4_-j 1C
State:_/ _
Phone No. f, C) <i 7 & do-a-1 q
ZipCode: 3 i-1 5' 3 7? _ Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( If different
E-Mail: C_ oe-3 C, r, C dram-.
.� L•
from the Owner listed above)
State or County License: <-
If value of construction is $2500 or more, a RECORDED Notice of
is requires.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: 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 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 recordi
Signature of owner/
r Notice of Commencement.
as Agent for Owner 'Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S `f COUNTY OF S f L L_I— "C_ _
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this LT -day of i ~c . (_ , 20�` by this f -5—day of c� L -{ , 20 1 by
I Ay(�
Name of person Tgking statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary P Ivan
R
TAYL H GAGNE
Commission No. Notary(B@tr_State of Florida
Comrnissinn # GG 293167
�1Y Commission Expires
January 21, 2023
REVIEWS FRONT ZONING SUPERVISOR
COUNTER I REVIEW I REVIEW
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
1z.___z Ctr Gc_(�"e- -
Name of person making statement
Personally Known L---OR—Produced Identification
Type of Identification
Produced
-1 6.1�C
(Signature of Notary
Commission No.
PLANS VEGETATION
REVIEW REVIEW
� (QR GAGNE
SVota is -State of Florid
Commission # GG 293167
My Commission Expires
SEATURTLE I MANGROVE
REVIEW REVIEW