HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `'
Date: �' �• 7� SCANNED Permit Number: Vag?• .�%� J' L)
Building;Permit Application FEB 14 2018
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 FEB NfI8
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:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
ojured uvr'��11(0�YvtV5 I I v
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be erformed under tis permit - check all apply:
-11HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
OElectric Plumbing HSprinklers Generator Roof
Total Sq. Ft of Construction: V0 S . Ft. of First Floor:
Cost of Construction: $ Tp�r}� Utilities:OSewer DSeptic
Building Height: !� r
OWNERAESSEE:
CONTRACTOR:
Name d 'Q 6r
Name:
Address: O �h
Company:
City: State: FL
Zip Code: 3 /L Fax:
Phone No. p ?� ( a SV �
Address:
City: S�
Zip Code: �a1
5_
State:_
Fax: ��o� � �`7�3
E-Mail:
Phone No. 7
E-Mail:
5 .
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County L ense:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 vour Notice of Commencement.
iJl'_Q.
Siinature of Owner` Lessee/Agent
STATE OF FLORIDA
COUNTY OF,I J%)
The for oing iristrument was ackno ledged before me
this day of a-rr 20 fby
(j ), L lam "- r-
(Name pf-person acknowledgingK
(Signature)own
Notary Public- StagOd
kida )
Personally OR Prod Identification
Type of Identification Produced _�Z_ _1�)L
Commission No. (Seal)
Y2,11 '. s
Sig ture of ont ctor License Holder
STATE OF FLORID
COUNTY OF P-H n
The forg ing instrume t was ackno ledged before me
this day of (a120 L&by
(Name of p son acknowledging )
(Signatie of Notary Public- State oTyF ri &T
Personally Known �OR Produced entification
Type of Identification Produced
Commission No. 6q1 _3 (Seal)
YVo a' REBECC
Revised 07/ 15 MY COMMISSION # GG91863
OF hOP EXPIRES: May 17, 2021 „' RE-BECCA RESTIF0
Qa if G91863
g•May
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATIO
S
GROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
VIEW
REVIEW
DATE
COMPLETE
I N ITIALS