HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -2 2 ,D ` 18 Kipin Permit Number:
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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
W
FEB 2 0 2018
I !. Lucie Cpyn
ty, Permittin4
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED ''IMPROVEMENT ^LOCATION".
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:: "
Lot No.
Block No. - -
01V 7tie- VooZ
\ t5 C�
CONSTRUCTION INFORMATION::"-
Adclitional work to ( Gas Tank QGas Pie ne orme un er t is permit - check
1jHVAC LJ
— Piping
a
apply:
_ Shutters
Q Windows/ Doors
Electric 0 Plumbing
Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $ c�73OC�
Utilities:nSewer 0Septic
Building Height:
OWNER/LESSEE: u
CONTRACTOR:
Name_ ���c-���1�,.ica�`aC�-
Address: _
City: �'.�5 — tate\�
Zip Code'3y 0 0 Fax:
Name:����� \�\
Company:
Addreess:`"\ Q\
City: �C�`�4� �� State: L
Phone No.
Zip Code:Y'Fax:
E-Mail:
Phone No..n'n2. -
Fill in fee simple Title Holder on next page ( if different
E-MaiL• ��n� Q�R�� ��2t 1 C �5�1
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL,CONSTRUCTI,ON ;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 TITLEHOLDER: _ 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 reco[ding vour Notice of Commencement. I
of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF F O STATE OF O COUNTY OF � ,> G �- I COUNTY OF \-.!!, c—\ 2.
The for instrument was acknowled d before me
thi��ay of -V- � , 20 by
\ Name of person mating statement
Personally Known OR Produced Id itcation
Type of Identtific do�j �Q'���r'S _L_ `2 , O
Produced �2 '� 47
(Signature of No
rP���,,�� STELLA M. HUNTER,
Commission No. 3 2r' +S Notary Publi(SeWte of Florida
+'=Commission # FF 180552
+
My Comm. Expires Jan 23, 2019
REVIEWS I FRONT COU TER I ZONING REEVI W I SUPERVIS
REVIEW
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The f going inst ment was acknowledge before me
this day of N 20� by
Name of person ma g statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature (kQ*. tarvZut is -State of Florida )
STELLA M. HUW$I)
Public - State of Florida
Commission # FF 180552
My Comm. Exnirac Aan 01i
oona a through National Notar Assn.
PLANS VEGETATI N GRO'
REVIEW REVIEW REVIEW REVIEW