HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFOMUST BE COMk6ib FOR
Date: V 2..'- I Y` SO
BY,
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Building Pe
DN TO BE ACCEPTED —
Permit Number:
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it APPlicati-
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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
PERMIT APPLICATION FOR: To Select from
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name: /
Project Name: �(is
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side:
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, click arrow at the end of line
Lot No.176 5
Block No.
Left Side:
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CONSTRUCTION INFORMATION:
itiona wor to e ertormed under this permit — c ec all apply:
E1HVAC Gas Tank ❑Gas Piping I Shutters Q Windows/Doors
13 Electric 0 Plumbing Sprinklers 11 Generator JD -Roof Roof pitch
Total Sq. Ft of Construction: (>a S . Ft. of First Floor:
Cost of Construction: $ Utilities:]Septic Building Height:
I
OWN ERAESSJEE:
CONTRACTOR:
Name l' c i S
Name: Cc.S
Address: qU3 S U
Company:
City: State:.
Address: / f
Zip od 7�qq'i_-7 Fax:
City: Stater
Phone No. 770 2 37— 4 ��// (0
Zip Code: 3qaq-7 Fax:—/'�Pa97—TJ(,i3
E-Mail:
Phone Nlo. ` 77 0�7
Fill in fee simple Title Holder on next page ( if different
E-Mail: • Chub .
from the Owner listed above)
i
State or County L' ense: CCZ
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ;
SUPPLEMENTAL CONSTRUCTION LIEN LAW, INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable I
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone: I
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby ' ade to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to th I issuance of a permit.
St. Lucie County makes no representation that is gran
which is in conflict with any applicable Home Owners
structure. Please consult with your Home Owners Ass
t will authorize the permit holder to build the subject structure
rules, bylaws or and covenants that may restrict or prohibit such
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 undel
accessory structures, swimming pools, fences, walls, signs, screen
WARNING TO OWNER: Your failure to Record a Notice o
improvements to your property. A Notice of Commenc
before the first inspection. If you intend to obtain finar
commencing work or recording our Notice of Comme
going a full concurrency review: room additions,
rooms and accessory uses to another non-residential use
`Commencement may result in your paying twice for
ement must be recorded and posted on the jobsite
cing, consult with lender or an attorney before
nement.
Si re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contra cto /License Holder
STATE OF FLORIDA
STATE OF FLORIft&w:a
COUNTY OF ;qaj i P7
COUNTY OF
The for oing instru�r�e�nt was acknowledged before me
The for oing instru ent was cknowledgeg before me
this day of /I/I r-Cn 20�by
his day of 20 by
Name of person making statement
I Na6J of p son making statement
Personally Known OR Produced- Identification 5r--'
Personally Known OR Produced Identification
Type of Identificati��,
Type of Identification
Produced PL_ I�'1_
Produced
I
I
(Signatu a of Notary Public- Stat of o )
Via
(�igna re of Notary Public- St e f Florida )
Commission No. ��� R EC �)
I mmission No. Cil
-1
r MY CO ISSIdN 4 0091116;
:��"% REBECCA RESTIFO
oFr� EXPITt�8: MILY I1, 9021
MY COMMISSION # GG91863
��O EXPIRES: Y
,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATI f
I!r
ROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
I
COMPLETED
tev. 8/2/17