HomeMy WebLinkAboutBuilding Permit Application•
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
CQU hITi;
F 1. P R 1 O A
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349,92
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 IMPROVEMENT LOCATION:
Address: i D 7 PU rf- iU 01-
Legal Description: �01)0 1.2 w v rve (�VS 0 2-
I s. f I +
Property Tax ID #: 3� D-7 - DD [ r 01) 0 - Z Lot No.
Site Plan Name: Block No.
Project Name: VQ ech I L I i-oply
Setbacks Front Sack: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
►'1GQ r)'J[�� ��l GCr?��f 6)6 5t L� �,1-,c��S �- � ¢�4�
CONSTRUCTION INFORMATION:
Add i Iona I work to be ertormed under this perms - ch,cl all fn apply:
13HVAC Gas Tank [].as Piping _ Shutters IEWindows/Doors
U Electric Plumbing Sprinklers E Generator L Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ / `7 r,70 tp Utilities :11Sewer Septic Building Height:
71
OWNERAESSIEE:
CONTRACTOR:
Name
Name: P1 S
Address: 7 G+ s� IC,
Company: r
r
City: L,4 • �Ct State:
Address: 1 7 S
Zip Code: CQ Fax:
City: State:) /-
Phone No. J? J-J,/ u
Zip Code: `t t Fax:
E-Mail:
Phone No. S - L!b 5
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECURMU Notice or commencement is requireo.
•
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Na me:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Na me:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:.
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
commencin work or ording your Notice of Commencement.
nature of Owner/ L ssee/Contractor as Agent for Owner
Signature of C ntr or/License Holder
STATE OF FLORIDA
vc)-e
STATE OF FLOR ❑
COUNTY OF
COUNTY OF
The forgoing instrum ntwas acknowledged before me
The forgoing instr ment was acknowledged before me
this �'�iay of
2f1� by
this( day of 2Q 1 by
r
V CC�'3 0 0
Name of pens❑ making statement
Name of person rfaking statement
Personally Known OR Produced Identification
Personally Known i OR Produced Identification
Type of Identification
Type of Identification
Produced-46 v ers UuUa
Produced
o
(Signature o Notary Public- Stat ❑
ure of No ary P u bl k2eState of Florida }
EBAN ESPINAL
Commission No.
oSW
2r )MY COMMISSION #HH
ission No. (Sew)EXPIRES24
AUG20, Z
Bonded through 3 st State I
urarrce
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
RATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/ 17