HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL!hPPLICA+B-�LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DaIile: / C�• Permit Numb
��I>�NED
S k Lucie Caw&
Building Permit Application
Pla�,,�llning and Development Services '
Bu►JVing and Code Regulation Division
23& Virginia Avenue, Fort Pierce FL 34982
PhoCI ne: (772) 462-1553 Fax: (772) 462-1578 Commercial F
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JUL 2 3 2018
Permitting epartment
_;§t,,+Lgcie ounty, FL
PEI�'
IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR(S;PC►SED
M,PRO.VEMENT`LO'CATIO'N
Address:
Legal,, Description:
Property Tax ID #: ,) c iU�-i lX
I,
Site R an Name:
Projel t Name:
\ - ccx> - 3
Lot No.
Block No.
Setblllcks
H
Front
Back:
Right Side:
Left Side:
C DTILED
DESCRIPTION OF 1NORK "�
Ph
COt STRxUCTION INFORIVIATIfON ;-
itional work to be nerTormed under this permit- c ec a apply:
F]HVAC LJ Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total cl. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ /C�(�� Utilities:Sewer Septic Building Height:
III
"OW NER/LESS'EE j
CONTRACTOR:
Name,l
Name:
Company: P&G Q,
Address: i 2C�1e of t �3 ui
_
City: tf�/CQ Stater
Zip Code: ,3�Ois2 Fax:
Phone No.
-U7 22�-i - �J�iZQ
Address:
City. State:kL
Zip Code: 3�Z Fax:��7_-�� P�
Phone No. 4CP t_ �y/��`<(
E-Maid :
Fill in
from the
Ill
Le simple Title Holder on next page ( if different
Owner listed above)
E-Mail:
State or County License:
If valuelof construction is $2500 or more, a RECORDED Notice of Commencement is required.
Amh
AOL
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW�INF.ORMATION:
. a
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
_
Na i� e:
_
Name:
Ad, ress:
Address:
Cit State:
City: State:
Zip Phone
Zip: Phone:
FE
SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Na'
e:
Name:
Address:
Ad Tess:
City:
City:
Phone:
Zip: Phone:
Zipll
OWO" ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certkfy that no work or installation has commenced prior to the issuance of a permit.
St. Lu�ie 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 cc Isideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acc' rdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The f lowing building permit applications are exempt from undergoing a full concurrency review: room additions,
acces structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
TIory
WA WING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
imprpvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befo�e the first inspection. If you intend to obtain financing, consult with lender or an attorney before
com miencing work or recording our Notice of Commencement.
Sign 'tu
Owner/ Lessee Co ractor as Agent fo r,.��
Signat a of Contractor/License Holder
STATE
OF FLORIDJJ
STATE O LORIDA
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COUNTY OF
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The
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The f oing instr t was acknowledgfr
by
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this
day of , 20_ by
this day of 20
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N erson making statement
Known OR Produced Identificati na
Name o -person making statement a
Per o a own OR Produced Identifi ►r=�z-�•
Type
of Identification
�(ced
Type of I i ication
Pro
l�
Produced
(Signature of No y Public- State of Florida )
(Signature
of N ry Public- State of Florida)
Commission
III
No. (Seal)
Commission No. (Seal)
RE
EWS VI
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
Y
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
REC
IVED
DAT
COMPLETED
Rev. 8,
2/17