HomeMy WebLinkAboutBuilding permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date:
CC)UNTY
a k o
Permit Number:
Building Permit Application
Planning and Development services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential L'��
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �i % 5, ,•�� , l r ✓cr' +1
Legal. Description:
Property Tax ID #1': L6Q — - [
Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Front. Back: Right Side: -eft Side:
DETAILED DESCRIPTION OF WORK:
CO
UCTION INFORMATION:
work to •ewe orme un er
UHVAC
Electric
— cnecic a
LJ Gas Tank UGas Piping
1:1 Plumbing ❑Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:
Shutters Windows/Doors
Generator Roof Roof pitch
Sq. Ft. of First Floor: _
Utilities:Sewer Septic
UWiNtR/LESSEE:
Name •I- t
Address: 1-k-7 7' '
City: State:
i
Zip Code: �7 Fax:
Phone No.i O -7 3�f'- 3.,./ 7
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Building Height:
!Name: �,
Company: � Sr 4,r
Address: 372F�fe
City: , ; e l c A
Zip Code: 3 I:t�
Phone No. C, L/ -
E-Mail: L,
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
State: E
7
Z 4 �
r
1 c.-+ i
C)4s)3419_1
PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ucaICINCK/CIVC7lIV M Not Applicable
Name:
Address:
City: State:
Zip' Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
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 y work. or installation has commenced prior to the issuance of a permit.
St,
which is Ih confli makes no
any applicable HomeaOwnerstAssociationtru esabylaws or andpcovenants that build
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 recordin our Notice of Commencement.
Si ature of Owner/ Lessee/Contractor as Agent far Owner
J
s �
Sign ure of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA � i
COUNTY OF �j 1 ltiG e-. COUNTY OF �i K L�4
The forgoing instrument wak acknowledged before me
thisl3 dayoof :�2 !2c (� 20A Oby
Name o person making statement
Personally Known OR Produced Identification
Type of identification
Produced
{Signature of Notary
Commission No.
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Rev,8/2/17
The forgoing instrurri nt was Icknowledged before me
this 11 day of�� 20_ L_,J�y
Name of person making statement
Personally Known Ii' _ OR Produced Identification
Type of Identification
Produced
"se of FIQt1kWY MARTIN {Signature of Notary Pubi' - 51 nf Florid KE RAY MARTIN
Notary Public - State of Florida o a
Comm'0g GG 3a6354 `_ • Notary Public - state of Floridt
Commission No. :�i3 Cog� miss}qn # GG 34635a
y Comm. Expir s Jun ti, 2023 dt' My Col�7icpires Jun 18. 2423
Banded through National Notary Assn. Banded through National Notary Assn.
ZONING SUPERVISOR I PLANS
REVIEW REVIEW REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW