HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED goq_
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Date:41 Permit Number:
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By
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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
RECEii/ED
APR 0 51-
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Commercial Residential ` " cfe
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 135�)(o Q L)3 6-0 P) l�� �•
Legal Description:
Property Tax ID #++:
Site Plan Name: 1
Project Name:
Setbacks Front
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Back:
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Side: Left Side:
Lot No.
Block, No.
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit check a apply:
DHVAC TGas Tank Gas Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers 0 Generator 0 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ I Q"lrJ
Scn of First Floor: _
Utilities: Sewer 0Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ' I
Name:
ell
Address: LD OvOlUO
Company: i
City: VIA State��
Zip Cod .' F 1 —
Phone o.� O
ff
Address: 4\ -
City: �•ei0` State V
Zip Code: Fax(r(
Phone No. `� 1 ��'
E-Mail:uigAY
Fill in fee simple Title Holder of h next pageT'if differ
fmm the IOwner li ted a q e �Ql � '
E-Mail:
State or ounty License:
If value of construction is $2500 or more, ifRECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN 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: Applicatio I 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
or
which is in conflict with any applicable Home Owners Association rules, bylaws 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 OWNED: 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 tol obtain financing, consult with lender or an attorney before
com ndng work or recording our Notice of Commencement.
I
Signatu f Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID� , n
STATE OF FLORI q
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' COUNTY OF J�- L.11
COUNTY OF L —
The C(j g instrum a knowledg efl re me
this " day of � 20 it
The r i nstrum ns a nowledged I re me
this �of l t 20—I [2p
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Name of pe n making statement I
Name of peyson making statement
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Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification I
Type of Identification
Produced
I
i
Pro uced
reof Notary Public- State o a) j
oss
�g ature of Notary Public- State of Floridaion
No. ��1111�ii1c1 �� (Sea{[)
Commission No. (Seal)
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Rev. 8/2/17