HomeMy WebLinkAbout3312_001.pdfALL APPLIC LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: + Permit Number:
1 J
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
. 861- OOc-�'S --6b 0
Back: Right Side: Left Side:
Lot No
Block No.
DETAILED DESCRIPTION OF WORK: y -
�
'CONSTRUCTION INFORMATION:
Additional wor to ffGas
orme un ert is permE —c ec a
2HVAC Tank ❑Gas Piping
11 Electric D Plumbing Sprinklers
Total Sq. Ft of Construction;
Cost of Construction: $
OWNED/LESSEE:
apply:
_ Shutters Windows/Doors
Generator Roof Roof pitch
S Ft. of First Floor:
Utilities: Sewer El Septic
Name __>l-t1vJLA_\
Addres�: u
City: L� State:
Zip Code: Fax:
Phone No- a3 -q _ d _
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR.
Building Height:
Name: l i yu
Company: I 11 ({uic
Address:
I City: irk(] .S�ta�te:c /�J
Zip Code :'c3�2��� Fax�l"r
Phone No,
E-Mail: 0
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
f SUOLEMENTA1. CON' $TRUMON LIEN LAW FNFflRMARON:
DESIGNER ENGINEER:
Name:
Address:
City:
Zip: Phone,
:FEE SIMPLE TITLE HOLDER:
Name:
Address,
City:
Zip: Phone:
Not Applicable
State:
MORTGAGE COMPANY
Name:
Address:
Citv:
Zip: Phone.
Not Applicable I BONDING COMPANY
Name:_
Address.
City:
Zip: P ho
i
Not Applicable
State:
_Not Applicable
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 Counttyy makes no representation that Is granting a permit will authorize the permit holder to build the subject structure
which is in cor%ct with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Horne Owners Assoclation 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 our Notice of Commencement.
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Signature of wner/ Lessee/Cot
essee/Co raftor as A en or Owner
Signature of GlIbritractor/Licenst H&der 601
STATE OF FLORIDA STATE OF FLORf
COUNTY OF NiN Q\>J COUNTY OF zt j 2'c
The f oing instrsam t s acknowledged efore me The f oing instcurn w acknowled before me
this T day of _ 2E3�r this day of�_, 2fl�.by
Name of person making statement
Personally Known / OR Produced Identification
Type of Identification
Produced
(Signaturl�of 0tary Public- State n?'f-loriria 1
Commission 4- Qjy0'3)0 f
REVIEWS FRONT ZONING
COUNTER REVIEW
Name of person making statement
Personally Known �01R Produced Identification
Type of Identification
Produced
ry Public -State of Florida)
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SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17