HomeMy WebLinkAboutBuilding permit appALL APPLIC BILE I FAO BE COMPLETED FOR APPLICATION TO BE ACCEPTED
nMUST
Date:J - - Permit Number:
tiIJAZJI
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
1300 Virginia Avenue, Fort Pierce F1 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT _LOCATION: -- - --- --
Address:
Legal Description: �I`� LC!�`���� c
T�
Property Tax ID #: �J• s� Lot No,
Site Plan Name:, coc� i1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
--- — ---�
kit
CONSTRUCTION INFORMATION:
;t`
;on work to e e orme under (his perms - check a apply:
HVAC Gas Tank Addition
Piping _Shutters Windows/Doors
Electric 11 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $y`� Utilities;ct Sewer 11 Septic Building Height:
I OWNER/LESSEE:
CONTRACTOR:
Name
Address:
Name:
Company:
City: State:
A 9dress:
Zip Code. Fax:
City: State
Phone No. •S
Zip Code: �!Z&pU Fa_.q *2J �q+
E-Mail:
Phone No.
E-Mail:il'��,��L,�S.�;��
Fill in fee simple Title Holder on next page ( if different
State or County License: �f)�-T7
Commencement is required-
from the Owner listed above)
1
If value of construction is $2500 or more, a RECORDED Notice of
SUPPLEMENTAL CONSTRUCTION LIEN LAW tNFORMATK?N:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable MORTGAGE COMPANY:
Name:
State
Address:
City:
Zip: Phone:
7
Not Applicable
State:
Not Applicable I BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip: Phon
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
commencing work or recording our Notice of Commencement.
Signature of caner/ Lessee/Co r for as A &or Owner
STATE OF FLORA?
COUNTY OF '
The forzoi g instru ent was acknowledged Before me
this rf day of y 2,
rr �
k. L46A/V�j
Name of person making statemen
Personally Known %_,--- OR Produced Identification
Type of Identification
Produced
(Signaturl�of Notary Public- State nf'Ploriria 1
Commission 4.. �gYaao
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
--i- r'9
Signature of ntractor/Liceris H Ider
STATE OF FLORI
COUNTY OF
The fo ing instL t was acknowledged before me
thi�day f L� 20,Xby
Narne of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
Manatu f tary Public -State of Florida )
I
JOYCE wHA c-aqEG
_ •' , . JOYCE WGIiAUD-U&O
r MY W gqN # MY0OWW ON#W2U=kA A=r WM; aura 26.SUPERVISOR PLANSONREVIEW REVIEW