HomeMy WebLinkAboutBuilding permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Esunding 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
Address: I `
Legal Description:
Property Tax ID #: I I D01 Qao
Site Plan Name:
Project Name:
Setbacks Front Back:
I DETAILED DESCRIPTION OF WORK:
Commercial Residential
Right Side: Left Side:
Block No.
Ve ([� C� n) /-). r n
ce eir" (7-4 cue -_-
-7
CONSTRUCTION INFORMATION:
A itiona wor to 5fl
Orme undert is permit— check a app y:
E1nn
HVAC Gas Tank []Gas Piping _ Shutters Windows/Doors
11 Electric UPlumbing Sprinklers I Generator D Roof Root pitch
Total Sq. Ft of Construction: rr11
Cost of Construction: $ U 77L�
S Ft. of First Floor: _
Utilities -Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namea
Name:
Address: j
Company:
C=
City: L State: ^
Zip Code: �l 1 � t Fax: �---
Phone No. _ `;
Address: el
City:
Zip Code: 7 t
Phone No.
E -Mail: �6cl S
'�" Stater
Fax:
/
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
CQ G i 5D.1
i� — UM V %.Ul IaLr Ua.uun is ;Tt7uu or more, a KtLUKUCU IVOilce Oi LOrnmencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER; Not AppficabfeTNa
AGE COMPANY: Not Applicable
Name:
Address:
City. s:
State: City;
Zip: Phone State:
Zip Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY:
Name: Not Applicable
Address: Name:
City: Address:
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 resultjyrn your paying twice for
improvements to your" property. otice of Commencement must be recorded'and poste the jobsite
before the first inspection. If you in end to obtain financing, consuth lender orf an attorne before
commencingwor> or r�cordii ou Notice of Commencement. /
Signature of 4vrjer/ Lessee/Contractor a Ageht for Owner
STATE OF F(ORIDA `
COUNTY O ,nit -� �-
The going insirEimen wa knowled before me
thisLdq of ZM by
r\
Name of person making statement
Personally Known YL OR Produced Ident' c tion
Type of Identification
Produced
ignature of N ary Public-Sta e ofdFlp�
Commission o.0�4AL�� Notary Public State da
�9 Fticcaboni��
.A : _ My Commission FF 981647
Yoo ��•r Exccres 05)2812020
REVIEWSI FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Signature of
STATE OF FLORIDA
COUNTY OF
TheIr
of trntwsYTw�lzaore me
this
Name of person making statement
Personally Known _�� OR Produced Identificati
Type of Identification
Produced !
Signature of Nota u I'c- S f I r-
"Ay
"AT pu°' Notary Public State cf FI rid t
' �: aboni §ea�
'v1y commission FF 581647
~ 0 riM14� Expires 05128/2020
SUPERVISOR
PLANS REVIEW I VEGETATION 5EA LE MANGROVE
REVIEW