HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 VZ
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: _ _ 9---
Address: / S/1'
Legal Description:
2
Property Tax ID #: / / J� - %062 �QLS —��� _ Lot No. C9
Site Plan Name::. _ Block No. o;),
Project Name: // "Ae//D
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: '
Additionalwor to a er orme un er t is permit - c ec a app y:
EjHVAC 0,�Ga ank ❑Gas Piping Shutters Windows/Doors
Electric _Plumbing Sprinklers a Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor:
Utilities: oSewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name'- ( ' %� ,i _
Name: C}
Address: / h O f e-r1:.
Compan Ai
AddressZip
City: -,��, d
Zip Code:
State:
Fax:
City: iI T� �� �� i c State: �
Code: ifll'e' Fax:
Phone No. 77;� — 9f�, =- 0 2 kl6z
E-mail: �J /. ���
Phone No. 77.;- - 7 (r
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Fill in fee simple itie Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License:
...... ffl o IwuLe ui %,urnrrnenuemeni is requires.
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
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. --
Signature of Owner/ Lessee/Contractor as Agent f r Owner
Signature of Contractor/License older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The f�ing instrument was acknowledged before me
thi day of r'Y� 2QW by
The far ng instrupent was acknowledged before me
this day of 20,,�,/ by
Name of person making s ment.
Name of person making state
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature ofii airy PubliV State of Florida
(Signature of Nota u lic- St -at of Florida )
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KARLEYMARIEGIESYVARNEY
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SUPERVISOR
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19