HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COM
Date: -9)� •
PLE1'D FOR APPLI
SCANNI
BY
Building Pe
TO BE ACCEPTED
Permit Nurn
it Applicatior
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
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PERMIT APPLICATION FOR: To Select from dr
pbox, click arrow at the end of line er0c--p,.-
PROPOSED IM'P,ROVEMV E;NT LOCATION "
Address: y-7b l &Cadln _P--(- I
Legal Description: lC< _ - / -
(" �)Z 0274 - 1.7 �
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Sid
D.ETAILE'D tDESCRIPTI'ON OiF WORK
CONSTROCTIO'N INFORMATION:
Additional work to be Performed under this permit — c
IJHVAC L_I Gas Tank Gas Piping
Electric ❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ L'C&O61-S, 6� utili
Lot No.
Block No.
Left Side:
au apply:
_ Shutters ❑ Windows/Doors
FIGenerator of Roof pitch
Sq.-Ft. of First Floor: 3 —%
s: L _1 Sewer O Septic Building Height: acP
'OWNER/LESSEE:-,
.CONTRACTOR.: .
Name A; l 1 1 L i? J
Name: b-P
Address:
Company:
Address:
417(_
City: ,q-p-(22 State:L 7
Zip Code: Fax:
Phone No. a 5! I/--_ ��2
E-Mail:
City: State:
Zip Code: 15149( 7 Fax: ` 1_7a,_)9
Phone No.-77c-;) c-2ST
E-Mail:
1 171o5
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County Li ense: _ LCC
it value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION UEN
�AW INORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
I
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
1
I
FEE SIMPLE TITLE HOLDER: _ Not Appli
Name:
Address:
City:
Zip: Phone:
able
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 pr or to the issuance of a permit.
St. Lucie County makes no representation that is grantir g 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 ing Codes and St. Lucie County Amendments.
The following building permit applications are exempt f om 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 your Notice of Commencement.
Signature of Own / Lessee Co ntra ctof A Agent for Cwner Signature oKontractoT
/Lic se Holder
STATE OF FLORI '� COUNTSTATEY OFORIDA���,
COUNTY OF ��//jj
The f ping instrum t was a knowledged before
this day of 20 by
,a
Na of person making statement
Personally K own OR Produced Identificai
Type of Identification r)L
Produced P:E
(Signature Af Notary Public- State ofl
Commission No.
REVIEWS
The forgoing instrument was acknowledged before me
this 'Z) day of 201ES-by
NameJf person making statement
Personally Known � OR Produced Identification
Type of Identification
Produced
(Signatur) of Notary Pub ic- State
_ I rida )
Commission No. �� (Seal)
NtJl QW SUPERVISOR I PLANS VEGETATI
,MVIICWz1 t REVIEW I REVIEW REVI
DATE me IT E��ES.1NaY ►,
RECEIVED a�
DATE
COMPLETED
Rev. 8/2/17
GROVE
(IEW