HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
Building Permit Application
Planning and Development ices O�
Building and Code Regulationn Division Sh l
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 452-1578 Cammercial Residential
PERMIT APPLICATION FOR:
I PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID
Site Plan Name:
Project Name:
Setbacks Fri
Lot No.Z-k_
s Block No.
Back: Right Side:
Left Side:
DETAILED DESCRIPTION Of WOM-
- - -. _A , r I i _ n 7 L
VU 06 7 4—?S = , sh
/),/_.
CONSfRUCT10N INFORMATION: 1
permit -
_Mechanical _ Gas Tank _ Gas Piping
_ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: .7- Sq. Ft. of First Floor:
Cost of Construction: $ 16 dbe , 0.0 Utilities: _Sewer Septic
Windows/Doors
_ZRoof SI'�(2Pitch
Building Height: IQ 1
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address:
Company:
Cltyi r� QLState:Jl —
Zip Code:_ 4q!a Z-.. Fax:
Phone No. 1211
Address: a
City: State:_
Zip Code: 3f-I11k Fax:
Phone No 777
E-Mall:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail *C':'L\y
State or County License LCl QS73 In
Z
If value of construction is ZW or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: --V Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
80NDING COMPANY: --r _Not Applicable
Name:_
Address:
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 MAT RESULT IN TOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. W YOU INTEND TO OBTAIN FINANCING, CONSULT
WIT YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
/ I ) 4 A -
Sig ture bl Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 11
STATE OF FLORIDA
Lee.
COUNTY OF S i W L
COUNTY OF x
The f9rgoing instrument as acknow edge,T1 efore me
this /L, day of 5 20 l �by
The fo g ing instr ent as cknowledged before me
this day of 2- ljM by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific ion
Type of Identificatioy_
Produced uL
f
Produced L_ ��
1..
z
of Notary Public Pori
(Signature y d,�, yp, _Stale ),rem
is
(Signature of Notary Pub " }Flori �, u ,-GG'56251
Cm mssnv GG'-.c.
Et.
'`� ! Mq COTM Exa•6 Ge: io. 2C2
Commission No. (t&kft E*a Ge: -E df?
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z/7/19