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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST Date: Bui Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-15 4 FOR APPLICATION TO BE ACCE ) MANNED Permit Number: By 11rip Pnf ffif° ing Permit Application Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMP.ROVEIVIENT CO;CATIQN. ;Y, Address: Ll I I Legal Description: L Property Tax ID #: 4 —S6 1 = Site Plan Name: Project Name: o, r 0 Setbacks Front Back: Right Side: DETAILED DES;CRIPTION,OF SC310�fo©0 L4S Left Side: Lot Nola Block No. 0— CONSTRUCTION INFORMATION' r Additional or to be oerform6d under this permit-c ec all t=applv: OHVAC i Gas Tank 0 Electric Elplumbing Total Sq. Ft of Construction: Cost of Construction: $ Gas Piping "Shutters Sprinklers E]Generator S Ft. of First Floor: _ Utilities: Sewer F]Septic QWindows/Doors Roof Roof pitch Building Height: OWNER/LESSEE CONTRACTOR: . Name Name ©. Addre : Company: I l t) City: staicJS Address: p Zip Cod Fax: City:V LQJI\ Stabelw Phone No. �. `a.1 l0 a d��3 Zip Co Fax:1 M E-Mail: Phone No. Fill in fee simple Title Holder on next page (if different E-Mail: L from the Owner listed above) I State or County License: (O_- ®9T a (p Y If value of construction is $2500 or more, a RECPRDED Notice of Commencement is regwrea. i SUPPLEMENTA! CONSTRUCTION LIEN LAN INFORM4TION DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone I Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Apblicable BONDING COMPANY: _Not Applicable Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: I OWNER/ CONTRACTOR AFFIDVIT: Applicatidn 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 Coun makes no representation that is grnting 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 1 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 exemIpt 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 df Commencement must be recorded and posted on the• jobsite before the first inspection. If you intend to Jobtain financing, consult with lender or an attorney before commencing work or recording your Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORPA COUNTY OF COUNTY OF �}j—L� � forgoing The for oing instr ment was acknowledged before me The instrument was acknowledged before me c�� this day of , 20_ by this day of 20 by Name of person making statement I Name of p rs making statement Personally Known OR Produced Identification �_ Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced r (Signature of Notary Public- State of Florida) (Signatur f Notary Pub ic- Sta Commission No. (Seal) ;,•1;Rva�•.,, KARLEY MARIE GIESYNARN tary Flori Commission No. _.•�' eaJCom lsslon#GG0c — State 9801 Commission k GG 099801 My Comm. Expires May 1, 20 Bonded through National Notary A REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION, SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17