HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
emu , Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 I
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of fine
PROPOSED IMPROVEMENT LOCATION:
Address: �Q P' Lindi Q
Legal Description: 1 (; i y1 l 1(a E' '
Property Tax I
#: n j30-50—opo —000 V Lot No_
Site Plan dame: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[6ETA6ED DESCRIPTION OF t/VORK
CONSTRUCTION INFORMATION:
Additional work to e erforme under tispermii—check all h appy:
L=fHVAC G s Tank Gas Piping OGenerator
Shutters Windows/Doors
L=4 Electric IR Plumbing Sprinklers � Roof C] Roof pitch
Total SST. Ft of Construction: 5 Ft
of First Floor:
Cost of Construction: $ t Utilities: l_1Sewer ! ] Septic Building Height:
OWNERAESSEE: CQNT',ACTOR:
Name Nance: pe�\J 01'/
Address:.'s OLS - - Company:
City: 'V1 ZV State: -- Address: UAL
Zip Code: 36 Z Fax: City: U0 U � �i,;Q State: FZ-
Phone No- Zip Code: _ 9 Fax:
E-Mail: Phone No. rY71—: 1�` �
Fill in fee simple Title Holder on next page (if different E-Mail: �_ ' ltV�cl�p � C VVIN
from the Owner listed above) State or County License:
If value of construction; is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
commencing work or re_. . g your Notice of Commencement.
Signature of Owner/ Les�&/Co , r ctor asSAgent for Owner Signature of Contractor/ " ens Holder n
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF��
The fir, oing instru was i, owledgeo before me The f ing instru eR was a k ledgers efore me
this`..' y of L �1 `� 20; by this day of 20 y` �'by
Name of persor) m ing statement Name of person aking statement
Personally Known 7✓ OR Produced Identification Personally Known Produced identification
Type of Identiti ati I Type of Identification,
Produced I Produced
�IGo ua RJW D8DUOP
ignature of Notary PubliVMakAW 171911 (Sig ture of Notary of Fioricft Nemoga
zttta too f o4Iglalwo *z Comm�slon GGt01442
Commission No. pRni i$N I� (Sear ��.,, � Commission No. ?�
p * 4, 2021
Bonded thru Aaron !Votary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE---- ---- -- --- -— - -.- - -- -- ------ --- __ _
COMPLETED
Rev. 8/2/17