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HomeMy WebLinkAboutBUILDING PERMITALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 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`� c P > C c_� L_ C Ls- —!:Q e2C Property Tlx ID #: S-zp ©% - C� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: �7 �r c �. ��c-f'i� L.� C._ ...►.-r r CD ONSTRUCTION INFORMATION: 1 xnal w ork to YVAC be nerformed 0 under this permit -check all that app y: Gas Tank ❑Gas Piping _ Shutters Windows/Doors 11 Electric 0 Plumbing OSPrinklers Generator Roof Roof pitch Total Sq. Ft of Construction: Cost of Construction: $ ,� _0 S . Ft. of First Floor: , Utilities: 0 Sewer 0Septic Building Height: OWNERAESSEE: CONTRACTOR: Name Name: Address: It �; ��� Company:r.P, City: Lem Stater Address: r 14 - a.t. c�` -- Zip Code: (�'�"? Fax: City: 5: c_ State: i� [- Phone No. 2 5_-- I Zip ode:3 q 5'.Fax: E-Mail: Phone No. 1 in fee simple Title Holder on next page ( if different E-Mail: from the Owner listed above) State or County License: L c If value of construction is $2500 or more, a RECCIRDEu NOifee or %.ommencerneni 15 requIrea. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ^ Not Applicable -Name: Name: kddress: 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 cornmencina work or recordine vour Notice of Commencement. of Owner/ Lessee/Contractor as Agent for Owner I Sigfture of Contractor/License Holder STATE OF FLORIDA 4 STATE OF FLORIDA COUNTY OF -F r i' Grp � I COUNTY OF s: LL C r`e_ The forgoing instrument was acknowledged before me this fX day of � 2O�by Name of person making statement Personally Known a—"" OR Produced identification Type of Identification Produced ( gnature of Notary Public- State of Florida l �a The forgoing instrument was acknowledged before JHe °-�:,,,�• this /. -day of 20JS by Name of person making statement Personally Known a —FOR Produced Identifcati - L x Type of Identification Produced (Signature of Notary Public- State of Florida ) Commission No. No. ♦O.�P0.Y P,� �., a , `A �� �' Florida :h J (Seal) m ♦yS/�Y7�P� ' REVIEWS FRONT I' VISQR'' pir P S VEGETATION 51 RTLE'v ' MANGROVE COUNTER REVIEW REVI REVIEW ?/: - REVIEW DATE ECEIVED � ATE -0 PLETED � r Rev. 8/2/17 Florio Ell