HomeMy WebLinkAboutBuilding Permit ApplicationALL APPUC BLEqI MI T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
10
Date: Permit Number:
J
•
Building 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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED INPROVEMENT LOCATION:
Address: n
cvc� L -Y\o V-6
3 L
tv
Legal Description: � I 4AE
Lot No..
Property Tax ID #:
Site Plan Name,
Block No,
Project Name:
Setbacks Front Back! Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
VY, r
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CONSTRUCTION INFORMATION:
Additional work to be performed undei
OHVAC
Gas Tank
ectric
0 Plumbing
Total Sq. Ft of Constructio
Cost of Construction: $ kc
this permit—cheCK an Lout cil3ply *
Flas Piping FIShutters
11 Sprinklers 11 Generator
Scl. Ft. of First Floor:
Utilities:F7 Sewer� Septic
Windows/Doors
Roof
Building Height'.
OWNER/LESSEE:
CONTRACTOR: - I 1�
m I
Nam Y' 0.
, IC' -e "l, C-w UA
NarneA- e�CC\
Address*
0,
Company: fill
i4b irkc n
City: E� J StatetL.
Address: n)c- C I
Zip Code: Liq Fax:
City: St a t e
Phone No Q_q 6
Zip Code Di 0 Fax:
E-Mail:
Phone No.,-- ?3
Fill in fee simple Title Holder on next page if different
E-Mail:C',,'M'--� M ch on(c�,r'A i f -codaC ur
State or County L i ce n s e E C i
from the Owner listed above)
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
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 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 Horne 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR im►If71PR OR AN ATTnDNipy RRaR'ncir Dxrnnneiur_ vno in mwarc ne rnuuewrzur.r :
Sid of Owner essee/Contractor as Agent for Owner
Sig`na ure of Contractor/License Holder
STATE OF FLOPd
STATE OF FLORIDAC`VCOUNTY U
OF—, -
COUNTY OF (,) C .
The for ing instrument w,ps acknowledged before me
The f r 'ng instr ent was acknowledged before me
this y °f a --, 20 0 by
this ay of 2Q9Z by
Name of person m=OR
Name of person mak nggssttatement.
Personally Knownuced Identification
Personally Known ae:��OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Nltle
Nicole
;� Ccn�.;GG�S
,�
MMIGG3Sa0T5
(Signature of Notary Public- State Epp
(Signature of Notary Public ri k9S:NOV. i
Ttltlt i�i4NMl
No. BoWed
1Commission
Commission No �`'` (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. L/ i/ 19