HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � t 114 Z, ,- Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of tine
PROPOSED IMPROVEMENT LOCATION!
Address: 3? 5 0 Q N k �C
Legal Description:
Property Tax ID #: 114 Z '` V Q I - 0 0 0 Lot No.
Site Plan Name: Block:No.
Project Name:
Setbacks 'Front Hack: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'�P.n c% cl P�c��►r���� �jC? -Fe e+ �F� mdin Pcetk e
CONSTRUCTION
RMATION:
inder this oerml — check all that arw v:
OHVAC Li Gas Tank []Gas Piping
Electric � Plumbing OSprinklers
Total Sq. Ft of Construction: ,(
Cost of Construction: $ z 2 U Q• Q o!
Shutters
Generator
S . Ft. of First Floor: _
Utilities: 0 Sewer a Septic
L__.t windows/Doors
0 Roof Roof pitch
Building Height:
411i/NER/LESSE.E:.
CONTRACTOR: .
Name _ rV
Address: h `vd
City: Ta �i CC 01, U & State: FL,Address:
Name: F-7Cic Rc: ca f cty
Company_ ; v-1
b r'c n a n edet Ny e
Zip Code: 3 L 3 q I Fax: r _ _
Phone No. - 5 _ 0 0
E-Mail: cl n l Us S FC6 M L6L(,)L-L0A
City: re, r + �' : 2tt P. Stater
Zip Code: 3 Fax: �� q66- Q✓�qQ
Phone No. OS 0 Q
E-Mali: 1 + n u+z i A G - t)1 . oN?
Fi!l in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: � C_ 1 30Q!_l'7
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,UPPLEMENTAL CONSTRUCTION LIEN LiAV
►ESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City, State:
Zip: Phone
FEE SIMPLE TITLE MOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
41FQRMATION:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
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 confiict 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 work or recording Your Notice of Commencement. ,
FV_' 4mmt�� ,
Signature of Owner/ Les ee/Contractor as Agent for Owner Signature of Contractor/License older
STATE OF FLORIDA C STATE OF FLORIDA s + �.-(1Gr
COUNTY OF " " Lic-i 9, COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20_ by
Name of person making statement
Personally Known ' OR Produced identification
Type of identification
Produced
(Signature of Notaryy Public- S �gtnrF'ridggUtary Public State -of F
`4�, Chris L Woolley
Commission No. J ri f (SWOeOizG1 &
zs o
REVIEWS FRONT ZONING
I COUNTER I REVIEW
Rev. 8/2/17
The forgoing instrument was acknowledged before me
this day of 20_ by
C '" C i hf (I
Name of person making ttatement
Personally Known V_ OR Produced Identification
Type of Identification
Produced
of Notary
( otAry Public State of
ion No. �� �� S � � L Woolley
My Commission GG 1�
OF Expires 02/26/2022
S REVIEWOR REVIEWVPLANS IREVIEWON SE REVTURTLE
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