HomeMy WebLinkAbout1742_001ALL APPLICAQ8 E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: G _ Permit Number:
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 arrow at the end of line
! PROPOSED IMPROVEMENT LOCATION: _
Address: Ca._ lrt
Legal Description: G t - K„
Property Tax ID #; �1 •[ -
Lot No. l
Site Plan Name; O&A ou
Block No.55
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
vp\L 0&WY91TO 104 wc(— LQ,I''�4
I CONSTRUCTION INFORMATION:
Additional work to be oertormed un er this permit —check all appy:
HVAC Gas Tank Gas Piping Shutters
Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator
Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ J'7 Utilities: Sewer [] Septic Building Height:
6
OWNER/LESSEE:
_
CONTRACTOR:
Name v[ `�C *(
Name: A
Address: W
Company: �crV�
_y' r
City: �l State:
Address:
City.co �
Zip Code: �C1(6C�
State. f-z— %
Fax: �
Zip Code: " ��F--a,,,,xrr:
Phone No.. t e •Z�`~t �7
E-Mail: _ _
Phone Nor-vv 1—N-41Cj.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
vi'(S•C� s"*!
State or County License:
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:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER
Name:
Address: _
City:
Zip: Phone:
Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City: —_-
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip: Phone:
Not Applicable
State:
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 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 your Notice of Commencement.
Signature of wner/ Lessee/Co r oras en or Owner
STATE OF FLORID
COUNTY OF %,.J jrL
The forizalUng instrument Yps acknowledge 'before me
this day of �,- 2t79(6by
Name of person making statement
Personally Known •' OR Produced Identification
Type of Identification
Produced
(SignaturLlof N'Mrtary Public- State n`I'Fiorirla
Commission
REVIEWS I FRONT
f COUNTER
DATE
RECEIVED
f DATE
COMPLETED
Rev. 8/2/17
Signature of ntractor/Licen V Htilder 61
STATE OF FLORI
COUNTY OFZ-4j Qrn 1 JQiL
The +`oro g instZurren�s acknowledge before me
this day of �6 y
Name of person making statement
Personally Known J,/OR Produced Identification
Type of Identification
Produced
kion
tary Public- State of Florida )
ZONING SUPERVISOR PLANS VEGETATION I
REVIEW REVIEW REVIEW I REVIEW I