HomeMy WebLinkAboutBuildling Permit AppALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s
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 X Y
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
1n
Legal Description: � i -�L5�— LAVA-1. t —
Z
Property Tax ID #: g l ► — cr_) I Z--. — 01 C — Lot No.
Site Plan Name: Block No.
Project Name: / o_-)k l
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional o be a orme under t is permit — check all M
apply:
OHVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
UElectric Plumbing 11 Sprinklers E] Generator Roof Roof pitch
Total Sq. Ft of Construction:
r I� ��-"�� S Ft. of First Floor: _
Cost of Construction: $ _'t QDQ Utilities1f ewer [] Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r i° a C+
Name:
Company:
Address:
Address:
City: State: �
Zip Code: {�L 5~�L Fax:
City: Stuart
State: FL
Phone No.
Zip Code: 34996 Fax:
Phone No. q
E-Mail:
c)
l i
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
r ' C
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION _
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: Not App!icable
Name Name..—_ —
Address .�— • C. _ Address State i
Slate, Y! I city:- _— — —
Tp ,» Phone_ zip.Phone.` _
FEE SIMPLE TITLE HOLDER: K NY
Not Applicable I BONDING COMPANY' Not Applicable
Name Name
Address _ J_ _ Address: �—
City . _ _ is ty _
Lip Phone: 71p: Phone
OWNER: CONTRACTOR AFFIDVIT: Application is hereby made to obtain a pemmt to do the wort[ find rnstallsom as Inclaized
I cercly t'+at nn wc•t -sr r slal at o' I'as ca*menced prior to the tssuanre of a permit
5! l..n� Cnu�*v r•rakrs n rr�rn•-rr.rn that Is erar!'ry; a prrrnit wi]! authorur ;re errnrt t+o!drr [a bs,fid tRr sub;rsa structure
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s ructuSrnC asl^r a�su r wcl't ya�r Nor r Ownnerrs Arsncners silum and re•nnN your deed Ice�nanlr ct o s whkht �rorpp¢ruh!t5lt su[1
!n tuns-dera!-on or the gr anwit of this requested perm'C I do hereby age that I wit, !n alf respetts, pertam the work
in acromance with the approrrd plans, the Florida Buddr-K Codes and St. tune Courty Amendments
f',e foflowrg budd.ng perm't apo! canons are exempt from undergoing a full carrurenry review room adl;tiarm
acEessory structures. swirm ns pools, fences, Wa Is, signs, Screen roOr-n and a-essory utts to anOlhcf 'Jar fCLdent ll use
WARNING TO OWNER: Your failure to Record a Natice of Commencement may result In paying twice for
improvements to yot.r property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the lobsite before the first inspection. If you intend to obtain financing, consult
with lender or an artorney before commencing work or recording our Notice of Commencement.
S'g^a[ure ar Uw e / L^sic:/Con[ractar as Agent for Owrer ygnaturie or Confracteift-cerw Molder I
STATE OF FLORIDA
COUNTY OF
to for aff'vrntdl and subscribed before me of
al Pretence or�(OwIre Notarisation
i5 V,f M(e `�s `be,]021 by
STATE OF FLORIDA
COUNTY OF r+-'-
warn ;a (or a"'msedl an_ subscribed t0a�e rrc of
Ph 'cal P,r rice r U^I n otaniat,an
hisdya, 20 by
a.�• tom■+ � �.r�• s�■•,
Name of prison making sla[emenl Name of person mak,r$ statemertL
' Personally itnown i OR Produced Identif cation - Personally Known t OR Produced Identification
Type of Identi6canan Type of Identification
Produced _ _T 21 Produced ;0`!-- A
j (Sealtre of Notary Public
Cnmmiss on No "'yssr^r
RI V 1 V,'S rR0N I
('0JINTER
PAT1
RECEIVED
JAIE
COMPLETED
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(5enl} r�,[ors[m'sti
ZONING 5UPERVISOR PLANS
REVIEIV REVIEW REVIEW
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al Notary Bublic• St l(L�yLFiRrada }� �►`f`'"Y"'
Va marlrm ---- i isf all
VEGETATION SEATURfLE MANGROVE
REVIEW REVIEW REVIEW