HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED` f
Date: Permit Number:
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:
Address: 77 41a 7 M ®` vh-CaL f (2-6 P, -?T• ;Fz..3q
Legal Description: La oo 8, V,-A
P ro pe rty Ta x I D #: (-3ak CL,>k-1��-�
Site Plan Name: _
Project Name:MC�%cien
Setbacks Front Back: Rid Side: Left Side:
Lot No. -;i` /
Block No.
Aaaitionai worK to oe pertormea unaer tnis permit- cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters. / _ indows/Doors
_ Electric _Plumbing _ Sprinklers _ Generator v Roof Pitch
Total Sq. Ft of Construction: _ 3y Sq. Ft. of First Floor:
Cost of Construction: $ a -Do Utilities: —Sewer Septic Building Height:
tJW N ER�LE-�S�SEE:
CaNTRACTO,R:
Name )m QA .eg-�
Name:
Address: 2140 ? I.+/S �l�nn i�� a,�_
Company:
City: 1t7,- pre . ,. Stater/
Address: -76 1 t T`l9 u- Pau ('-
r
Zip Code: `; Q� Fax:
pp
City: -�� TC�12� State*-7
Phone No.
Zip Code: 34Q Fax: 4 6 8 - 6 2
E-Mail:
Phone No t14.T -0 e 0 Z-
Fill in fee simple Title Holder on next page ( if different
E-Mail_ 1 C Qyw aw ize>0 P118
State or County License eV'-C- iS-�- a66-4
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S'llC''RLEIVf.ENTAL C+C•NSTR+UCTIQN LIEN L,4W IICIR�MAT(DN:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
I
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
'
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
I
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, wall, 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 td obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Owner/.Lessee/Contractor as Agent ifor Owner ignat a of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by I this day of , 20_ by
(Name of person acknowledging) I I (Name of person acknowledging)
(Signature of Notary Public- State of Florida ) I (Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED