HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! f l:15- a-.-(_ Permit Number:
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:
�. R t)PCC SE tti[P EtViE VT.L C TION
Address: _ I
Legal Description:
C> r-4.-- ( _f �-
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IMENEW-41
5
)1,5 - /5/J
Property Tax ID #: � / - Lot No.
Site Plan Name: �.��� ° \� t� Block No.
Project Name: �"� /lG,+� l-r �ef
Setbacks Front Back: Right Side: Left Side:
CtNSTRUCTIlDl IIu.FORltir't/T(ON
Additional work to be pertormed under this permit -check all that apply:
,Mechanical _ Gas Tank —Gas Piping _ Shutters — Windows/Doors
_ Electric Zmbing _Sprinklers , Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
QIJVNERI.E$SE. , '
CG#NTF�CT(3i
Name:
Companycy-N,
CIA r�
Address: IU
Address:
City: -'T le rL_.
r
State: --
City: Sk �- C -e__ State: _
Zip Code: '_,?, �-A 4;.S"'L Fax:
Phone No. 7 7c;L " D L
Zip Code: 3q `t ��_ Fax:
E-Mail:��'��'u.-� �y A �l. L'evl
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mait--::�'%" fn
from the Owner listed above)
State or County Licensee'
If value of construction is 2500 or more, a RECORDED Notice of commencement is requires.
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: y
City:
City:
Zip: Phone;
Zip: Phone -
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as inaicareo.
I certify that no work or installation has commenced priorto 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, s;. imming 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 impROYEMENTS To YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED ARID
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING, CONSULT
aurrs• — — ■ rrnrn nn eat errnnnrev oecnnc ncrnunivur. Yf'niin NoTirF nF COMMENCEMENT." _
srac n4 n virsc �.sraucn use rur rxt •
-_ _ ___ ___ - _ -
Signature of Owner/ Lessee/Contractor as g nt for Owner
Signature of Contractor/License Holder
OF FLORIDA
STATE�
`
STATE OF FLORIDA j
COUNTY OF I i, U e
COUNTY OF v�•
The forgoing instrument was acknowledged before me
` 20M by
The forgoing instr4ment was acknowledged before me
this � day of sf 20 _ by
this day of i
Name of person making statement.
Name of person making ,, ement. i
1
Personally Known 4) OR Produced Identification
I
Personally Known OR Produced identification
Type of Identification l
Type of Identification
Produced
Produced n
f
(Signat re of NotaryPublic-St
nature of Notary Public- State of
L n ,XoY Notary Public State of Fiona
— } i}Ir ? r (5'o $a L 6uiterfiald
Commission NO. t on'nL ion GG 302065
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C mission No. i� + � eal}"° 1el ssa L Buiter Feii
g _ ': q e m,ss ca G4
r' pras 02 /14/2023
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REVIEWS
FRONT
ZONING
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
5EATURTLE
REVIEW
MANGROVE
REVIEW
COUNTER
REVIEW
I
DATE
RECEIVED
—
DATE
COMPLETED
ev.