HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: nio- unji,
e
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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,LOCATIO.N , _}
Address: oo ;1E
L I gal Description:
Property Tax ID#: 3 ` 0 s=6 0 ' 0 39 9 -- D®0 w Lot No:
Site Plan Name: Block No.
Piroject Name:
etbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION bF WORK , .
CONSTRUCTION IN,FOWATION
Additional work to e e orme under this permit—check a apply:
�HVAC E]Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers. E:]Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
17t�. y� E]
Cost of Construction:$ Utilities: _Sewer Septic Building Height:
OW,N.ER/LESS'fE CONTRACTOR:
Name `�.. . G. Name: _ e, c
Address: ' Company: ,
City: t _ Stat Address: o
Zip Code: �� �� Fax: City: Stater
Phone No. Zip Code: GL 7 Fax:2 72-LIa
E-Mail: Phone No.'7 7.�?-4164-511.E
Fill in fee simple Title Holder on next page(if different E-Mail: ODO & P
from the Owner listed above) State or County icense: t4 F7;4_t2c -7Q Q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: 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 icertify 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
commencing work or recording our Notice of Commencement.
Signature Owner/Lessee/Cont ctor as Agent for Owner Signatur f Contractor/License H der
STATE OF FLORIDA L�a�" STATE OF COUNTY OF FLORIDA 4W
COUNTY( t
The for oing instru ent as acknowledged efore me The for oing instr ent was acknowledged before me
this day of 20 L by this day of 20 by
c
' 4
pe.
erson making sta ment -,of-person making state ent
P rsonally Kno OR Produced Identification er na�Knovi �p_OR Produced Identification
Ty ntification ocation
Produce Produced
r - 69k �n ( 1
(Signature of Not 01 NT5iignature of N
LIBERIYA. ING ;y..°�;c LIBERTYA.IC NG
Commission No. . MYCOMMISS(GbI� 0fi38 Commission No. := MYCOMMISSION�H 38
EXPIRES:Vay 4,�021 i`� A EXPIRES:May 4,2021
TAN NOf31y .�f 4derwnlef5 '.wv-.r.� Bonded ThN Notary Pdk Underwriters
1 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED "
Rev.8/2/17,