HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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:
Address: o(y/ (,a p(, W,
Legal Description: ur 4
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Property Tax ID #:
Site Plan Name: �>
Project Name: l0 k EXf� rn
Setbacks Front Back: ,20 Right Side
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Left Side
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Lot No.
Block No.
;�,�LX/1�.`.�' _� • ` ON MOUR 1, •
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_Mechanical _ Gas Tank. = Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: is fh(( :120 . Sq. Ft. of First Floor:
Cost of Construction: Utilities: —Sewer _Septic Building Height:
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`N"PERLE�S�SEE:T
OW
CONTRA "iOR.
Name. r
Name:yc;..ve- C?oll-
Address:20IG
n Q Vlv . a Covf
City: �C (., C;% State:
Company: 3'iG Co,..flu S LLC
Address: wly S� /-ICCro!! , 5-
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City: Port � ["(eG Stater
Zip Code: Fax:
Zip
Phone No.
Zip Code: Fax:
E-Mail:
Phone No 772—.2/6 "Ic3L((,&
E-Mail ;7G, COd►'d PLUS Q o�-®(COM
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
if value of construction is 2500,or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Appli
Name:_
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Narne:_
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 C9cording vour Notice of Commencement.
t
Signatur of Owner/ Lessee/Contractor as Agent for Owner
Sig nat of ontractor/Lice Holder
STATE OF FLORIDA t
ST E OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing i trument was acknowledged before me
The forgoing ins ument was acknowledged before me
this 3 day 20_ by
this3) day of 20_q by
)
(Name of person acknowledging91
(Name of per n acknowledging)
r
igna ure of Notary Public- Sta of lorida)
(S ture of Notary Public- at f Florida )
Produced IdentificatioN
Personally Known OR Produced Identification
Personally Known OR
Type of Identification
Type of Identification
Produced
Crd�uced
mmission No. (Seal, AHNAtNGRA
LASH tat of
Com fission No, AM
totida . LASHAHN
o�"O'i �'� State of Florida .
.��` ill , r Public I)Pc
0 2018 ; ��"a act y Notary Public 018 .
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DATE
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DATE
COMPLETED
Rev. 7/2014