HomeMy WebLinkAboutBuilding Permit Applicationr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1,� ✓ f 1 Permit Number:
RECEIVED OCT 12, 7017
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:
Description: _
i' 14 (o I —
Property Tax ID #: '6I 0 .l -- 1 11 — O(A) I — U U U " v Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
�af-to13�
CONSTRUCTION INFORMATION:
Additional work to e Performed under tis —checkpermit a apply:
0HVAC be
Tank ®Gas Piping Shutters Q Windows/Doors
Electric 0 Plumbing ❑Sprinklers _ Generator Roof ® Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor ?moo
Cost of Construction: $ �eei Utilities: Sewer LffSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ) f
Name:
Address:
Company:
City: State.
Address:
Zip Code• Fax:
City:
-i"P State:
Phone No.
Zip Code:
Fax:
E-Mail:
ZZ--
Phone No. C�
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County Licens
it
If value of construction is $2500 or more, a RECORDED Notice oT commencement is requirea.
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:
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 pert, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida ullding Codes and St. Lucie County Amendments.
The following building permit app ' ions are ex pt from undergoing a full concurrency view: room additions,
accessory structures, wimmin oo s, fences, ails, signs, screen rooms and accessory us s to another non-residential us
WARNING TO O NER: our f ilure to ecord a Notice of Commencement ma result in yYat7rne
aging tw' a for
improvements t your rope . A ff��,00tice of Commencement must be recohded and d on t jobsite
before the first i speytion. I you i end to obtain financing, consult with lender or n efore
rnmmonrina %A/ rk nr rarer ina v lr Nntire of Cnmmerlcement.I
/r/License7r
Signature of Owh4rl Lessee/Con ractor as Agent for Owner
Signature of Contract
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The f rgoing instrU t as a kn ledge efore me
this day of F� 20J�by
efore me
The forgoing instrun t as ackn wl dgDby
this day of 20
0SIAA Gkiv �Icv"
wx
Name of per on making statement
Name of perso making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur of,y�Y Pu(~�i�,¢$bPrppf�I�J91jtZ
(Signature of Notary Publrc- R
'c MY COMMISSION # GcG�1�1�4�236
Commissj., r} `� June 13j'Zt72'7
'•.�,F'dF�,,.
Commission No '- MY COMMISSIOTIbI50114231
!��OF f' EXPIRES June 13 2�)21
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17