HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE- INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date' Permit Number:
a�
Building Permit Application
Planing and Development Services
6urlging 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 I M P
Addr ss:
Legal escription: _
ENT LOCATION:
ire..
PropeIr�i�
ty Tax ID #: aq
Site Plan Name:
I
Projedt Name:
Setbacks Front Back:
C01-5-1 010
DET ILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Right Side: Left Side:
°wncu unuc� uIm Nei rnII. - -q
0HVAC Gas Tank ❑Gas Piping
Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ —3 -3 Oct
Lot No.
Block No.
UShutters Q Windows/Doors
E]Generator El Roof u Roof pitch
S Ft. _
of First Floor:
Utilities:Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name—�w.,.,(c:.� t fir✓,►,
Name: (-13 '
117 In
Address: crl•c. Company: (1_JeT,+
City- State: � Address: "? � .,..—
Zip Code:,�/ :ii $� _ Fax: City: �� j: i .t State: A e—
Phone No. Zip Code: J Y'! 8�_ Fax:
E-Mai11: Phone No. & q — Sa c7
Fill in �ee simple Title Holder on next page ( if different E-Mail: �J MC
from tihe Owner listed above) State or County License:1 &-( 3 G �s %
if value) of construction is $2500 or more, a RECORDED Notice of Commencement is required.
J SUFPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
NGINEER: _ Not Applica
Narne:
Address:
City.: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
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 Molder to build the subject structure
which s in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
struct re. 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 fall concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARMING TO OWNER: Your failure to Record a Notice of Commencement may result in your Paying twice for
impr vements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor the first inspection. If you intend to obtain financing, consu't with lender or an attorney before
PomMencing work or recording_your Notice of Commencement.
of Owner/ Lessee/Contractor as Agent for Owner Signa re of Contractor/License Holder
STATE OF FLORIDA f , I STATE OF FLORIDA
COUNTY OF - .0 COUNTY OF - �c • -�
The forgoing instrument as a knowledged before me
this � day of e.a. 20,I by
Nam person Spicing statement
Personally Known _OR Produced Identification
Type bf Identification
Produced
of Notary Publ
Commission No.
w,i astir LUCWKE RAV MARTIN
Notary Public - State of Florida
` for -- GG 346354
My Comm, Expires Jun 18, 2023
Bonded through National Notary Assn.
EWS IFRONT ZONING
COUNTER REVIEW
RECEIVED
DATE
COM LET
Rev. 8/2/17
The ing instrument as ac nowledged before me
thisfor
of 20 lam`' by
Name of person malting statement
Personally Known FOR Produced Identification
Type of Identification
Produced
{Signature of Notary Public- 5 tW4lQrida MIKE RAV aARTM
g• Notary Public - State a' Flor
Commission No. '- �isslor r GG 3:6354
oFrti l r Cgmh+. z,arm .Lr ' 8, 21
Bonded through Namr.d, Notary A
SUPERVISOR PLANS I VEGETATION SEATURTLE I MANGROVE
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