HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATInnI-
DESIGNER/ENGINEER:Not Applicable
Name: �`
Address:
City: State:
Zip: one
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip-'— Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip; Phone
—Not Applicable
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,
which is inoconflicctt with any representation that
Owers granting
permit rulesaby bylaws or and permit holder
that build
drestrict orpF structure
s ch
structure. Please consult with your Home Owners Association and review your deed for any restrictions which ma apply
.
perform the
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respectsy
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.work
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 resut 'n your paying twice for
improvements to y9d-Pproperty otice of Commencement must be recorded an
before the first inspect on. If you intend to obtain financing, consu 'th len fir o, npatterne beforesite
commencing wor,' or recording your Notice of Commencement.
i ,
Signature of 0-1r er/ ';I )l a Agent for Owner I Signature of
STATE OF F OR1DA STATE OF FLORIDA
COUNTY O COUNTY OF
JJ_ Ulyrc�t,�,C
The for ing instrument sac nowledge before me The f oing /stru ent was acknowled efore me
this da a€ I�Yl tt 20. by this da of
i 20oby
Name of person making statement
Name of person making statement
Personally Known OR Produced Ident" c #ion Personally Known._ OR Produced Iden#ificat"r
Type of Identification
Produced I � Type of Identification �1--�`
(Signature of N karV Public- Stae of FI
Commission
p�p�n�QG Notary Public StatetSf fjprtda
11
iccaboni
My Commission FF 981647
Expire5 05/2812020
REVIEWS
FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
`\
CDmrnISSlOL"P
Notary Public S4ate of FI ridaboni {;eal}
My CommissioFF 981647 Expires 05/2812020
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
��3•� III
Building Permit Application S
Planning and Development Services pc�V' �
Building and Code Regulation Division �� f� � peI+:-
23l7Q Virginia Avenue, Fort Pierce FL 34982 tt,.u� 9 t �
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential a
PERM IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: i7 i
Legal Description:
r C)
Property Tax ID#: tisP �,.�-
Lot No.��
Site Plan Name:
Project Name: Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
amm- q
-3 -Ps 41, �.
CONSTRUCTION INFORMATION:
�t�ona war to e e Orme un er t
f1eQl0.c_Q c1otY .
is perm,t— CF,ecFc all apply:
HVAC Tank DGas
_Gas Piping
n
L ] Shutters
LJ Electric Plumbing Sprinklers
Generator
Total Sq. Ft of Construction:
Sc. Ft. of First Floor:
Cost of Construction: $ Utilities:
0
Sewer
Septic
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: 'j
Company:
City: I State:
Address:
Zip Code: Fax:
City: 1
Phone No.
Zip Code:
E -Mail:
Phone No77Q
Fill in fee simple Title Holder on next page ( if different
E -Mail:
from tate Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
v F[Fuvws/IJoors
Roof Roof pitch
Building Height:
Fax:
�IVN