HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:...,3 if Z3 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Legal Description:
Building Permit Application
Commercial Residential
Property Tax ID #:7` %,% - 00 Lot No.
Site Plan Name: .� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
CONSTRUCTION IN
,dUi—ti vvor to e pe
_Mechanical
Electric
FORMATION:
rTormecl under this permit - C eck a
_Gas ank _Gas Piping
_ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
16) 7s--
iat apply:
_Shutters —Windows/Doors
Generator — Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
Name " r
Address•l�,
City: .2 Stater
Zip Code:-% Fax:
Phone No. 7 1"".— el
E-MaiKt'lp z2 _, /. e—e,,.-i
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR
Name: r �ZP.4
Company:/��,-�
Address:_}
City: ���-� St ate
Zip Coder?(5�', 2 Fax:
Phone No 77-.2 Z/ I -- o 2 11
E-Mail f Yt9t�y'T /ca' (_.� �� r cx,
State or County License . �f O,frC)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
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 such
prohibit
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 �S/, 1-�- c; z
COUNTY OF :5> •
The forgoing instrum t was acknowledged before me
3 -zA l
The fo4oing instrum nt was acknowledged before me
�
this day of 20a by
this J day of (76.f-C 20!21 by
Name of person making stater
Name of person making state t.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
VCL4XO
f (Signature ary Publi State of Florida
(Signature of Notar u lic- St t of Florida )
rll�rw.�+
Comm s KARLEY MARIE GIESYNARNEY eal)
E—sa4eofFlorida
Co "^ KARLEYMARIEGIESY'VARNEY
(Seal)
. ' Commission 1 GG 09g801
.: Comm, Expires May 1, 2421
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= ° ' Commission 0 GG 099801
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Banded throuORaft
Wary Assn,
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a Wary Assn.
REVI
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SUPERVISOR
PL
LE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19