HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1914
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division % Ppd
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 11��
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDrIIVIPROVEMENT LOCATION
Address: ( � I CI
Legal Description:tQ &WOO 4 JQq244 61 / 6/ i� /1)3JV
09 � Of 1 670 l 3 / 3 /V) ' o rZ l W(' - /P
Property Tax ID#: /30/ — 000 — / Lot No. 1 ,, 1
Site Plan Name: Block No. /g3>i
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK f ' l
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I K l/ 614 1 kMdr S-V 2 6n[Sh Y ki4d C ri
CONSTRUCTION;INFORMATION
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Additional work to be nertormed under tispermit—check aln appy:
HVAC Gas Tank Gas Piping _Shutters 1ndows/Doors
Electric 0 Plumbing Sprinklers Generator _Roof Mizzoof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
01lVNER/LESSLE 'CONTRACTOR - n
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Name -e P- �� ane: �.
Address: � �en �� Company: O�
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City: State:/G7— Address:/00 A6 e
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Zip Code: � Fax: City: )`Yc Stat
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Phone No-6220 5 Zip Coder(11M2__ Fax: S&;-- 9I55J'
E-Mail: Phone No. r—
Fill in fee simple Title Holder on next page(if different E-Mail:• S WCqI
from the Owner listed above) State or County License: CC L 032-Q ER
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENT'A'L CONSTRUCTION LIE2.1
N LAUV 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 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 thepermit 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 Commencemen
s/04��
Signature of Owner/Lessee/Contractor as Agent for Owner Signa ure of Contractor/L(4nse Holder
STATE OF FLORI STATE OF FLO A
COUNTY OF R- t Ul C4'-e-- COUNTY OF_ .1,4,4 C4e--
The forgoing instrument was ack owl ged before me The r oing instrument was acknowledged before me
this_day of 20�by this day of SCD /) �/2n� by
Name of person making st tement Name of perso ng statement
Personally Known loo' OR Produced Identification Personally Known VOR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. �� (Seal) Commission No. ��/D� �1 (Seal)
,:t P� Notafy Public State of Florida
,r'�'P�9 Notary•Public Stats of Florida
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Jennifer J CF 960029 ennlrerd .5REVIEWS FRONT -,-2 IV YWIS0R RUNS VEGETATION' 17 E`A.;�,r��' ,=' ..1si nF 960023
,° Pirs� rL� #�z9, ANGROVE
COUNTER :' 10. , � E1�V RE /IEW REVIEW;� ,a rEU U � ARE I vP/ a
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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