HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED g�- bqy2�
Date: lV-1Jr 10 Permit Number:
-8
Bui_ A Application Perm",-
9 Oe�
Planning and Development Services LUFIe ea rt ent
Building and Code Regulation Division cy
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED I.IVIPROVEMENT LOCATION:
/ a
Address:: tl qq & 14MY Z4,ne Aegj- Pierce 7rZ , 3a q,
Legal -Description:
Property Tax ID #: �7� r �y�- / -"��� " Lot No.
Site Plan Name: Block No.
Project Name:
Setbac s—Front Baek� Right Side 11
g L`eff-Sides
DETAILED DESCRIPTION OF -WORK, `~
i. ,J .'i,Sf„
is X116 17.f1Gho r4o �'12,17knd
�i+
;CONSTRUCTION fNFORMATION
Additionalwork to �jbe nertormed under this permit- check all app y:
E1HVAC LJ Gas Tank Gas Piping _Shutters a Windows/Doors
11 Electric El Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: ! Z S . Ft. of First Floor:
00
Cost of Construction: $ Utilities: Dewer Septic Building Height:
O-W�N`ER%L`'ESSEE.,. t ,,
CONTRACTOR
f�IVame .s _d
Name:
Company:
Address: rl9& '4gle !'JG
City:6pf l/klze State:FL
Zip Code:3NM4, Fax:
Phone No. 4/0- 9137 ` 73 V1%
Address:
City: State:
Zip Code: Fax:
Phone No.
E-Mail:
E-Mail: S♦Sfo36e10e, QMIJ -COW)
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or Cou License:
If value of construction is $2500 or more, a RECORDED Notice of Commencenfent is required.
SUPPLEMENTAL CONSTROial LIEN LAV1/ INFORMATLO;N
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
G ,i//�
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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
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 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 recording your NoticyMmencement.
ntractor as Agent
STATE OF FLORI
COUNTY OF
The forgoing instrument was acknowledged befo 9d=ft„
this 15day of (2� 20 bye
anOm L n S�.r,,at�r
Name of pe on making statement
Personally Known OR Produced Identification
Type of Identification
Produced- I
(Signature of Notfy Public- State of Florida
Commission No.
(Seal)
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of , 20_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
REVIEWS
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
nII�
RECEIVED
�g
DATE
COMPLETED
Rev: 8/2/17 -% \