HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICAtION TO BE ACCEPTED
Date: Permit Number 116-a 00 1
a Q_UCIe c0wty
ED
Building Permit App icatte::!
Planning and Development Services m
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Perm ng
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the. end of line l v 4 j
PROPOSED IMPROVEMENT LOCATION:
Address: 3 e, �'� 1 Jt=N P>ffi
Legal Description: 1-18 RA'-1 668
y
Property Tax ID #: LAS -;L" Sol— 63
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No._
Block No.
•SF,-(-0
P1q
DESCRIPTIONDETAILED OF •'
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CONSTRUCTION. INFORMATION:,
itiona wor to e e orme under this permit -check a apply:
11HVAC 13 Gas Tank [--]Gas Piping _ Shutters Q Windows/Doors
Electric ElPlumbing Sprinklers ElGenerator Roof Roof -pitch
Total Sq. Ft of Construction: 7CF6 U t I S . Ft. of First Floor:
Cost of Construction: $ 13 (] d .- Utilities — Sewer E]Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
J
Name
Name:
Address: s
Company:
City: Stater
Address:
Zip Code: Fax:
City: State:
Phone No. ?:
Zip Code: Fax:
E-Mail
Phone No.
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 regwrea.
..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 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.
Agent for owner
Signature Contractor/License Holder
Signature of Owner/ Lessee/Contr or as
of
STATE OF FLOR124
STATE OF FLORIDA
COUNTY OF ,-
COUNTY OF
The fo oing instrur ent was acknowled before me
The forgoing instrument was acknowledged before me
this day 20_ by
this day of 20 by
Q="
of ,
Name of person mak g statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced �J�' L_
Produced
A
�%-"5fa+—a\
(Signature of N K. E GIVENS
(Signature of Notary Public- State of Florida )
Y COMMISSION # GG 022023
Commission No. :. IRES:De&*6,2020
Commission No. (Seal)
Bonded Thru Notary Public Underwriter',
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
R VIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
�,
COMPLETED
I
Rev.8/2/17