HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' &' Permit Number: 0 nc,
SCANNED
BY
Building `r�rr�it Pplication
Planning and Development Services FEB 12018
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:�� ���IV
Legal Description-T dIOJi�—
'3S 1Qi-CP Z3410' ����tt ,i `t
Property Tax ID #: 34Da —CDOO 00`q /"--�Cc�o Lot No.
Site Plan Name-1 C16J (���r r ��� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
k--�add Arno ,--P—r`l
�4-) v, 11 �d
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit- check all apply:
F]HVAC LJ Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 4 `lS . 1 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameLi'�'1 kl��
Name: G 1
Addres
Company: 1
I'
City: r + �(. Stater
Zip Code: ) Fax:'' (�c''II--l(��
Phone No.11C�- ^'JA"4-
Address:
ity: )
Z/iip CCood�e: -34-�-Z I
P�br1e Flo. /
State. r
Fax:— - -W0O�
- 1J
E-Mail: i
l
Fill in a simple Title Holder on next page (if -rent
from the Owner listed .above)
E-Mail: (
I
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
i
S.UPPLEMtNTAL,CONSTRUCTION'LIE'NIAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address:
City: I State:
City:, _ State:
Zip: Phohe
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: Zip: Phone:
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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 1plans, 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: Yourlfailure 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 inspec 'on. If 'you intend to obtain financing, consult with lender or an attorney before
commencing work orefecordjhg yoLjAotice of Commencement.
Signat re of 0 er/ Zsseq/ifontractor as Agent for Owner
Signature C tractor/License Holder
STATE OF FLORIDA NL -e
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STATE OF FLOR?Q, Wp
COUNTY OF
COUNTY OF
The f r i stru t w)s a5 cno ledg., efore me
this day of 20y
Th fn irlstru e . t a nowledged before me
this dray �f20 by
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Name of p r ma ing statement
Name of person making statement
Pe o ally Known OR Produced Identification
Personally Kno n OR Produced Identification
Type of Iden ' is do I
P uced ` �� �!�
p of Id ti ' a '
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+Signa ure f Notary Public- St a of Florida)
S' natu a of Notary Public- State of Flor a-)
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Rev. 8/2/17