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HomeMy WebLinkAboutBUILDING PERMITALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �L` r Permit Number: Building Permit Application Planning and Development Services 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: Address: - legal Description: „_ t -- i L �S �� C ---�/v gnnr' -- -. lei Property Tax ID #: I-% 1_0 rQ 1 ° 4 Q O c0 to O � Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: 'DETAILED DESCRIPTION OF WORK: C ti r <-- f 3 )S, �- CONSTRUCTION INFORMATION: 9Qiti na workto e e orme under tispermit-c ec a apply: HVAC 13 Gas Tank ❑Gas Piping _ Shutters Windows/Doors Electric Plumbing OSprinklers ElGenerator Roof Roof pitch Total Sq. Ft of Construction: tstj C�o S . Ft. of First Floor: Cost of Construction: $ �J� Utilities Sewer � Septic Building height: OWNERAESSEE: CONTRACTOR: Name T e Name: J,.� Address `� Company: City:., r State,.I � Address: % Zip Code: t Fax: City: -� State:_,,�C_ Phone No. ' 7 1 > 1 Zip Co e: -6 1-3 Fax: E-Mail: Phone No. g 4 ° ill in fee simple Title Holder on next page ( if different E-Mail:(- arm U- ► t± from the Owner listed above) State or County License: C— C- I S-/ If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAWN INFORMATION: NEER: Not Applica Name: Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER: Not Applicable Name: Address: City: Zip: Phone: MORTGAGE COMPANY: Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: _Not Applicable Name: Address: 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 riorida 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 tender or an attorney before commencing work or recording your Notice of Commencement. 34nature of Owner/ Lessee/Contractor as Agent for Owner I s4gnat5rd—of Contractor/License Holder STATE Of FLORIDA 1COUNTYOF STATE OF FLORIDA, COUNTY OF LC, C._ f The for oing instrument was acknowledged before me this for of Z_ 42Z— 20Zy by Name of person making statement Personally Known OR Produced Identification Type of Identification Produced_ _ Z2 & _ The forte ing instrument was acknowledged before me this day of S 20� by Name of person making statement Personally known OR Produced Identification Type of Identification Produced 6' SHE (Signature of No �8&- Stat , AG N E [signature of No r Y gy R�i�� a of Florida ?z° Notwy Public -State of Florida =• 'a Commission # GG 293167 `* Commissiar�� 293167 Commission No. "4 �;� IlY Commis 8lpires Commission No. = Commission Expires January `��Q1 3 January 21, 2023 ANG REVIEWS FRONT ZONING PIANS ICOUNTER I REVIEW 1 5 REVIEWOR, REVIEW V REVIEWON S REV EWEE MREVIEW E RECEIVE© ATE ;OMPLETED Rev.8/2/17