HomeMy WebLinkAboutBuilding Permit Application Nor
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: Permit Number:
1� • ��O
Now
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 IMPR01/EMENTi LOCATtC?rN
Address:
Legal Description:
PlropertyTax ID#: 3 'L L S�D•�`�as`�O� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET�►ILED DESCRIP7"IONl,0F WORK j. �" l
CONSTRUCTION IIVFORMATIO,N s; F
jAdditional work to
e nertormed under this permit—check all that apply:
IHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ❑Plumbing L]Sprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction:
v0. . Ft.S of First Floor:
Cost of Construction:$ 6 U o-- Utilities: _Sewer[—]Septic Building Height:
011VNER/LESS;EE CONTRACTOR
nu�. .
Name 2 1 Uc Name: AI e-1 k n 61�Address: (6 _ � Cti Company: &r(- -
City: S770 Slate:.)Ct Address: 7.� .Ld o l0i
Zip Code: e,U Fax: City: i State:
Phone No. 7_ t; O Zip Cod i �� Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: n�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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- I,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: T Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
j 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.
StI.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
efore the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commenculg work or recording our Notice of Commencement.
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A
Si na re 6f Own /Lesse / ntractor as Agent for Owner S' n re of Con1Tact6r/Li6eVAe Holder
STATE OF FLORIDA / STATE OF FLORIDA /
COUNTY OF roGj�C COUNTY OF �17" C%
The forgoing instrument as acknowledged before me The fo�r oing instrument as acknowledged before me
this�day of �� �' cr►^ �' 20j by this-F� ay of , [R- l 20 by
ML-Aci—I)C�/ &/�_ i�lad'f&�1/1(XJ V I CL)
Name of per aking statement Name of perso aking stat ment
son
Personally Known �OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature
{ tio Qf (Signatur f.Nq`xo tf ' ,�My
. a IS eS.BIOaaNF Fr F
Commiss RODA E O® ) Commiori.N, M s IV 01. d�
9MY COMM43411 /FF3�
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EXPMES.*01•21HS tC7)398-0153 1`10ridaRlo4aiy3etvlcs.eom
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVJEVY REVIEW REVIEW REVIEW
DATE
1
RECEIVED J'7
DATE
COMPLETED �9
Rev.8/2/17