HomeMy WebLinkAboutPermit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Fa R 1-
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
Address: `'t
Legal Description: _
Property Tax iD #: Ol ` 1c19 " 3 — C=(.a — CU 0 " l Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side, Left Side:
DETAILED DESCRIPTION OF WORK:
1.
CONSTRUCTION INFORMATION:
Additional work to U nertormed un ert ispermit—c ec all In apply:
1JHVAC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
11 Electric 0 Plumbing Sprinklers I3 Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $0 Utilities:0Sewer O Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name " 0-1U
Address: C7 QcJ_'
Name: ,�u
Company: WC3
, r
`
City: .� - c -� State:
Address: �� Qle—� ``-
Zlp Code: 3 t{ 9 Sri Fax:
City: �. '
State:
Phone No.
Zip Code: t
p
Fax: L o (/— � 7
E-Mail:
� t.
Phone No.
� �
Fill in fee simple Title Holder on next page ( if different
E-Mail: W O �y
from the Owner listed above)
State or County License:
it value or construction is 5Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION: I
NEER: _ Not App
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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
commencine work or recordiins< vour Notir-p of CnmnnPnrPmant
Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Signatureaf Contractor/License Holder T
STATE OF FLORIDA i
COUNTY OF
STATE OF FLORIDA
t e
COUNTY OF
The forgoing instruWnt was acknowledged before me
this OIL day of �--e-PL^ ' 20� �' by
The forgoing instryAie t was acknowledged before me
this,�l day of � LA20�ZGby
Nam of person g statement —
Name person making statement
Personally Known OR Produced Identification
Personally Known. OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notar u� u fate o F �UYiMARTII:
of Flo Y RAY MARFIN
(Signature of Notary !�atar is State of Florida
No�ry Public 5iitr �# Fl�ridi
Commission No. ''�' `' CQrnMi55 &ea G 346354
� �
a
_ Cor;;(59 r = J n 18, 2
Commission No. .".rc•�=(Ssel�s furs #8, 2013"�
E
.-#7F— ` My Comm. Expires Jun 18, 2023Ionded
:'^ gri yatianal Notary Ai61t.
through Nationat Noti y AM.nCeC
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17