HomeMy WebLinkAboutBuilding permit appALL 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: To Select from dropbox, click arrow at the end of line
I PROPOSED IMPROVEMENT LOCATION: I
Address:
Legal Description: L e.i).ic�c—� Rjrk--()nl:- (-D—BLX_ �d 1 LCAS 44 Qtr'd J C I�.�F%�Z�
Property Tax ID #: Iy ` Lr�L- �t-� (�-" Lot No.
Site Plan Name: Block No. ((7)rl
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
30 x )-4 0
Co-,� nU-0_k� EA C).b
Ci nb :30 x 4 b x l -A
Cyr
b1ci��r
no fluml?ir) j
no eC►,,i C (1,o
of riv6 Wa
CONSTRUCTION
INFORMATION:
Additional work
1]HVAC
to be nertormedunder
L_J Gas Tank
this permit -check all that
❑Gas Piping 11
apply:
Shutters a Windows/Doors
_
11
Electric
Plumbing
Sprinklers
M
Generator
E]
Roof
Roof pitch
Total Sq. Ft of Construction
Cost of Construction: $
1200
1tots C11D
S . L. of First Floor: 20 o
Utilities: 0 Sewer-O Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name' aL
Address: L-WnA
. Name: Q01 V120 1(+'
14 rl U u TIQLt► e.,
Company: YN*Yl-Q.5 -F)
City: E e -i ce-, State: l_(_
Zip Code: 1 15 I Fax: L
Phone No.
E-Mail: CLf -; 22-CC Q CLQ I .• iris
Address: V, �O�C
City: S�IV{C2.
Zip Code: 31209 1
Phone No. 2`4
Stated
Fax:
"
Fill in fee situp a Title Holder on next page (if different
from the Owner listed above)
E-Mail: C rrvi 4 t- t
C v OV a
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Cn
Signature of O n r/ Lessee tractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA V-'�—p
COUNTY OF ;� rk A c. �
COUNTY OF tt
The forgoing inst m en was acknowledged before me
The forgoing instrurrient was acknowledged before me
/
this) \:�': day of J 0rv.cu L_� 20,)k by
this day of JQJ L- 202 by
( %,_�-1u E'dS )0,,y,-
Name of person nt
Name of person making statement
Personally Kn OR Produced Identi ' ion
Personally Known �' OR Produced Identification
Type en-ification
Type of Identification
Pr uced L,,l,, ;,
Produced
(Signature of Notary u ic- ate of Florida)
(Signature of Notary Public- State of Florida )
Commission No. I (Seal)
Co mYNptARIA pQ„pq eal)
.: Commission # GG 362849
Expires August 25, 2023
ouncooru froy Fain ins
ranee 800-385-7019
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C 0 M LEAkp�
Rev. 8/ ��`.` Notary Public State of Flo da
Commission # GG 082461
,Ny�UF F4'' My Comm. Expires Mar 13, 2021