HomeMy WebLinkAboutBuilding Permit Applicationi
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / u r :
Date: / _ f J 17 Permit Number'•. /
Building Permit ApplicatioNCT' 1 2017 0
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 Y +� •vim
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PERMIT APPLICATION FOR: p r)
PROPOSED IMPROVEMENT LOCATION, .
Address: b
Legal Description: e� tV
21
Property Tax ID #:
Lot No.—t-t_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONS, RUCTION INFOR MATIONAdd•
iti na workto a performed un er t is permit c ec a t:;h-utters;:
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� HVAC Gas Tank _Gas Piping p g Win ws/Doors
Electric 1�Plumbing Sprinklers neratoof R f
Total Sq. Ft of Construction: Sq. Ft.,bf First Floor: _
Cost of Construction: $ (\) Utilities: — Sewer — Septic
OWN ER/LESSEE' `
CONTRX
Name . C'
Name: ID
Address:
Company:
City: ' , State:
Address: '
Zip Code Fax:
City:
Phone No.
_3(
Zip Code: _
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or Ce
'OR
Building Height:
k�50A State:
Fax:
License: I. C`i 2
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
A
DESIGNER/ENGINEER: Not A '
pPlicable
Name: MORTGAGE COMPANY: Not Applicable e
Name:
Address: Address:
City: State: City:
Zip: Phone State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Irl;111- t - .
I
Signature O#rl 0Lessee/ gent for Owner Signa o Con ractor/LFense$k4ger
STATE OF FLORIDA ` STATE OF FLORIDA
COUNTY OF_ ':--b k `V- COUNTY OF _ Sk I L'
The forgoing instrume t as acknowledged before me The for SQing instrum nt was acknowledged before me
thisday of O CJ w 20� by this �"aay of c3c lo •e %. 201 � by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Name of person making statement
Personally Known C/ OR Produced Identification
Type of Identification
Produced
r4a L�
(Signature of Notary Public- State of Florida )
Commission No. ' MA DE LA() VELASCO
COMMISSION 0 GG050388
•. , ,.•• EXPIRES November 28, 2020
Commissio
MA DE LA LUZ VE C
��
`IrAYV`C61wtWfS510N at GG0303
�'•, , ,. EXPIRES November 28, 2020
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
COM PLET
Rev. 8/2/17