HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED —1
Date: Permit Number:
rin RIECli9
Building Permit Application rDEC 18 2017
Planning and Development Services PiTT!, 4
Building and Code Regulation Division St. Luci
2300 Virginia Avenue, Fort Pierce FL 34982 `' r
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: U01 ENVY io& Q
Legal Description: —d J7&re& 3 `Z q Kv4
Property Tax ID #: �3�� • S� o� ' l7 OQJ8• 0 00 (o Lot No.
Site Plan Name: Block No.
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be pertorme.d-,under tis ermit-checka apply:
OHVAC I'_�I.GasTarik asPiping _Shutters aWindows/Doors
Electric Plumbing -' USprinklers —Generator El Roof Roof pitch
Total Sq. Ft of Construction: S . Ftofof First Floor:
Cost of Construction: $ Utilities: Sewer 0 Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name &-
Name: 6�17 tiezzA.24,j?P
Company: SPr tj- �.A &-
Address: a ,h &Lre
City: pyr-r Sa; I tg=y State: ► L
Address: I)"o '7 jti QGV?,'
Zip Code: 3 �- � Fax:
City: � G141-1 a r\ Stater
eS�6
Phone No.
Zip Code: 2>3 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
J
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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 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 recordine vour Notice of Commencement.
�
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ignature o wner/ Le ee/Contractor as Agent for Owner
nat r f con ractor-/L' a Ho
STATE OF FLORIDA
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STATE OF FLORIDA
OF i,�
COUNTY OF /C- •
COUNTY
The for ing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
day 20l'i by
this day of �� , 20 by
this of
�21(,/�CName
of of person making statement
Name of person making statement
Personally Known Produced Identification
Personally Known OR Produced Identification
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tion
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Type of Identification
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Commission No.
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DATE
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Rev.8/2/17