HomeMy WebLinkAboutBuilding permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0pf Permit Number:
a
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 �(
Address: � 0,i, S 46l.0 V\Q_+ �,yp
Legal Description:
Property Tax ID #: 4 ` ( c °' (?/} Q --O o -o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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4- i"ilory
CONSTRUCTION INFORMATION:
Additional work
OHVAC
to e e orme under this permit -check
F] Gas Tank ❑Gas Piping
a apply:
Shutters Windows/Doors
a
41 Electric
�
Plumbing
Sprinklers
_
O
Generator
0
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1 j
SgFt.. of First Floor: _
Utilities: I _J Sewer F]Septic
Building Height:
OWNERAESSEE:
CONTRACTOR.
NameWJ!!d,PX T� ac'J JA
Name: F-ric Le_'t®urnCcW
Address: (°. �i
Company:"
Address: 35 0 4 JFa nan ecl& N V G
City: F0 State: F L
Zip Code: Fax:
Phone No. I L -5 7- 0 q (� \
E-Mail: ({)fit\ q 7 1 LM 4 V-7o\5OUA, � � �.
City: n r 4- �' 2Cc_ State:%
Zip Code: 3(4qt'`7 Fax: 712-- y66- 050
Phone No. M7%2- `1�6` QSOo
E-Mail: A i Ce 11Q+z- i ,, c ir�q � of . conk
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: tiz C 1 0!5517
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 ork or recor in�` our Notice of Commencement.
Signature of Owner/ Lessee] ntractor as Agent for Owner
Signature of Contractor/License hfolder
STATE OF FLORIDA
COUNTY OF S L it G� G
STATE OF FLORIDA
COUNTY OF L t>r
The forgoing instrument was acknowledged before me
this day of GAGbe( 20 2-1 by
The forgoing instrument w s acknOwledgeq before me
l-,day 0C- C
this of O 20 21 by
_ r`� S � n
Name of person making at�t ement
Name of person making1tatement
Personally Known Y OR Produced Identification
Personally Known V' OR Produced Identification
Type of Identification
Type of Identification
Produced
lic State of Florida
VIV
Produced . Public State of Florida
a4 Chris L Woolley
7 � a My Commission GG 185665
a4 Chris L Woolley
my commission GG 185665
v4,! Expires 02126/2022
vs+�°~� Expires 02/26,12022
.�'
ON
(Signature of Notaryc- a e o Florida )
(Signature of Notary ublic- State of Florida )
Commission No. (Seal)
Commission No. 66$ (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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