HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address ' a q F o4S- " Ex S ui 5 � CF, P +
Legal Description:
X
Property Tax ID #: l U 2 - 6 0 % 00 76 -000 Lot No.
Site Plan Name: Block.No.
Project Name:
Setbacks 'Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
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CONSTRUCTION INFORMATION:
itiona wor to e e orme under this permit -check a apply:
E�HVAC 13 Gas Tank []Gas Piping _Shutters L� Windows/Doors
Electric F� Plumbing Sprinklers F]Generator 13 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 0
S . Ft. of First Floor: _
Utilities:0 Sewer F]Septic
Building Height:
OWNER/LESSEE;
CONTRACTOR:.:"_..'
Name e -�
Name: F—ric L fio t'nett�l
Address: 701 'E�J,�_O.S c S -�-
Company:
Address: 504 "Fo-n+ari eclat
k V e
City: JP+ P e cu State: �'L,
Zip Code: Fax:
Phone No. 7196 ' Z In - 771 1
City: T-a r } t!c t', Stater
Zip Code: 31gg 7 Fax: " 72, q6b- 0$9D
E-Mail: ,- `
Phone No. +7(46` Qsoo
Fill in fee simple Title Holr on next page ( if different
E-Mail: A i Ce RQ+2 ) A c �9 N 01
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State or County License: t-z C �00S51
7
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.-
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: _ Nat Applicable
Name:
Address:
City:
Zip: Phone:
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
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Signature of ontractor/Li ense Holder
Signature of Owner/ Lessee/CoFftractor as Agent for Owner
STATE OF FLORIDA S
-� Luc-)
STATE OF FLORIDA s L-t1Gr
COUNTY OF a
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
iday Sip i2 b e C 20Z( by
this' `stay of pep +Sm h P. ( 20� by
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Name of person making statement
Name of person makingdtatement
Personally Known it OR Produced identification
Personally Known ► _ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
{Signature of Nota Public- State of on Notary Public State
of io ,n u of Nota ublic- State F o i a
;Q Chris L Woolley
Commission No.✓ > My Commission G
tary Public State of F
`C'IRris L Woolley
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sue Expires 02/26/2022
=Qewfniss'nNo.56�yqoy�
9 ". M Commission GG 18
cs n Expires o2/26/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17