HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Le s
Planning and Development Services wilding 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
PROPOSED IMPROVEMENT LOCATION:
Legal Description: U, Co vl�' — + I �t , -7LC)t- iCC
.
Property Tax ID #: n l GCZ
Site Plan Name: Lot No.
Project Name: Block No.
Setbacks Front— Back: —Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
C- AP �� iA1 n� 13.E 1 cdoo
ASS — Y:-Q—p 16-62 i - N U S L I
� Iow -Z-7 L I
CONSTRUCTION INFORMATION:
itiona wor to In
e orme un er t is permit - c ec a a Pp Y
C�HVAC _Gas lank Gas Piping Shutters
Windows/Doors
Electric ❑ Plumbing ElSprinklers ElGenerator
Roof C� Roof pitch
Total Sq. Ft of Construction:
c r 1 S . Ft. of First Floor:
Cost of Construction: $ 1 -1 j `� 1icl _ 3 Utilities:_ Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name � r
' Name: �{-e'
AddrAs: Com an
�1
City: p Y' `S
S Stater• Address.
Zip Code: Fax: City: II-7—
Phone No. State: 7- �
Zip Code: 7 Fax:
E-Mail: Phone No. Li
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) !' �(
State or County License:
U
11 value of construction -is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN
LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Address:
Name:
City:
Address:
State:
Zip: Phone
City:
State:
Zip: phone: --
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BANDING COMPANY:
Address:
Not Applicable
Name:
City:
Address:
zip:Ph
Citone: y'
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.
. Lucie
urt t
no
n that Is
which ch is noconflicmtawith any applicableiHom Owners Assgopationiru esill aby bylaws outhorize r and cohe venants that build the
restrict of subject
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 resu�t 'n your paying twice for
improvements to yau`rrroper y�otice of Commencement must be recorded and poste the jabsite
before the first inspect on. if ou to end to obtain financing, consuth lendorgan at orne before
commencingwork or rpcordfn our Notice of Commencement. 1
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Signature of O 7rjer/ Lessee/Contractor as Agept for Owner Signature of Contira`ctor/License 1 i� de l
STATE OF FfORIDA
COUNTY Ott r: f^G,
The for fng instr nent was ackn ledged.befc
this a ofi] �l by
Name of person making statement
Personally Known OR Produced Ident'�
Type of identification
Produced
( ignature of No a Public -Stale of rip
Commission 0'� "Y v�e4 Notary Public State �� F prida
o iccaboni 11
� o� My Commission FF 981647
p�OF fl4Q Expires 05128,12020
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
STATE OF FLORIDA
COUNTY OF I,'
me The f rgoing his
this of
Lf4t=- t
Name of person making statement
Personally Known y` OR Produced Ide
Type of Identification �^�1
SUPERVISOR PLANS
REVIEW REVIEW
re
by
�.CY PLm` Notary Public State of Fi rid
y Q My Commission FF 981647
?oio�= Expires 05/2812020
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VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW