HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
6CANNED
BY
Building �i,�ermit Applicatio RE-EIVED
Planning and Development Services
Building and Code Regulation Division MAR 2 2019
2300 Virginia Avenue, Fort Pierce FL 34982 I
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED.IIVIPROVEJVIENT LOCATION��1`'' r
Address: —10 d(—n ] ors
Legal Description:
Property Tax ID #: 1 � 1 tD 1 4— DI �E5q 0001 Lot No.
Site Plan Name:i:�! �LOni+fleIQ Block No.
Project Name: , h
Setbacks Front Back: Right Side: Left Side:
DETAILED DESGRIPTI'ON OFWORK
OCR ed)C .,
L_.-j
CONSTRUCTION INFORMATION
Add itional work to be nertormea
. un er t is permit— cec all app y:
❑HVAC. _ Gas Tank ❑Gas Pipi g _ Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.
of First Floor:
Cost of Construction: $ Utilities: L_ISewer ❑Septic Building Height:
OV1/NER/LESS:EE
CONTRACTOR
4
Name,,_)�_ "f'�- _ !
Name:
O�Xf'rl
Address: ►� % i I
Company:.
-
City: ) —�� . State:
Zip Code:u F 110
Phone No.1 1— �
Address:
an- _
City:
Zip Code:
Phone No. d`
Sfat
Fa �6 : iIWO
E-Mail:
Fill in fee simple Title Holder -on next page ( if di„ e' n
from the Owner listed above)
i
E-Mail:
is on I
I
State o County License: W�2
If value of construction is $2500 or more, a RECORDED
of Commencement is required.
i
SU,PPLEMENTALeCONSTRUCTION Ll'EN LAW INFORMATION;:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: State:
City: State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
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
is in Home Owners Association bylaws that may
which conflict with any applicable rules, or and covenants 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 requestedlpermit, 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 record.ing your Notice of Commencement.
Signature of Own •/ essee/ ntractor as Age t for Owner
Signature dt C&tractb/r/License Holder
STATE OF FLORIDA
STATE OF FLORIDgC-"' I
L
COUNTY OF
The c r i st m w wledge (fore me
this day of 20 y
COUNTY OF
The r nstr m n k ledgejd fore me
this i ' d y of 20 `l �y
-(Q
1 1 IC
1` 4� e—A- aw ra J)
Name of a on making statement I
Personally Known OR Produced Id�enyification
Name of pd>ts�n making statement
Personally Known OR Produced Identification
Type -dent' is
_�_
Type of Ide tif'ca�na-(.t �(
`C� L ouD I
Produced u
c
Produce ��' 'v"
.
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( igna re of Notary\Q\0MUi8fdCp�Florida )I
S.n ture of Notary ublic- State of Florida )
p IF E
Commission No.`��Qi; ��,Missro2��,0 !(Seal)
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DATE
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COMPLETED
Rev. 8/2/17