HomeMy WebLinkAboutBuilding Permit AppALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date; ! 6� 2 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
PROPOSED IMPROVEMENT LOCATION:
Address: j \L
Legal Description:
Property Tax ID #: 1 ~7 (� - 0000 _ 00 0 - g Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
f0
,epCLCEOX:
CONSTRUCTION INFORMATION:
Adaitional work to be Derformed under this permit - Check all apply:
0HVAC Gas Tank []Gas Piping Shutters Q Windows/Doors
LNElectric r Plumbing F-]Sprigklers F]Generator 1-3 Roof Roof pitch
Total Sq. Ft of Construction: S�Ft.J( of first Floor:
Cost of Construction: $ Z2� a Utilities: LSewer OSeptic Building Height:
OWNER/LESSEE:LESSEE:
CONTRACTOR:
Name ki J( v\ d,\4-GL
Name: F r i c � �'} caufn�tctl
Address: 2 � U kcbo r blvJ
Company: W'; (e r\y+c_ j n G-
City: 1:7f- Pi2rc2 State: (i
Address: 35 b 41 -�'o ii+gn ecl& V e
Zip Code: �`'t q o Fax:
C ty:. "6 r 4- Stater
Phone No. 7i
Zip Code: 14 q 47 Fax: z%Z b6- 0520
E-Mail: a " C
Phone No. 7�2 _ C4 6 " 0s o o
Fill in fee simple Title Holder on next page (if different
E-Mail: W i f nv+� i A C 99 c • C-ONi
from the Owner listed above)
State or County License: 1E L 150065 17
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION: .
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: ' Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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, t 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 jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
rnmmpnrinu wnrk nr rprnrrfinrs vniir Nntirp_ of Commencement_
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA S
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STATE OF FLORIDA s �.-{1Gr'
COUNTY OF
COUNTY OF
The forgoing
r��oing instru ent was acknowledged before
me
The forgoing instr ment w s acknowledged before me
6 N0. Vt'M of 202,1 by
this !� day of ve, e _, 20� by
this ay of
GN-� ri s Ytl OCR l,,PAA
�hLn(? f l e_ j4
Name of person making statement
Name of person makin tatement
Personally Known ' OR Produced Identifica on11'1
Personally Known ✓~ OR Produced ldentifscati
Type of Identification
Type of Identification
Produced
oU.
Produced
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W
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C O
(Signature of tary Public- State of Florida)
o
(Signature of No ary Public- State of Florida)
a o .y N
Commission No. �� (Seal)
a L X
Commission No. �� ✓r (Seal)
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REVIEWS
FRONT
ZONING
S
Ei�JI�<�R
PLANS
VEGETATION
SEA TURTLE
M
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17