HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICAB MUST PLETED FOR APPLICATION TO BE ACCEPTED r(�
Date: bM Permit Number: NO v
Building Permit Application
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 Residential vv✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROP,QSED fMPROVEMENT LOCAT{ON -' s
- -
Address: 33 1 u
Legal Description:
Property Tax ID #: �C4 I V ` `
Site Plan Name:�IM�
Project Name:
Setbacks Front O Back:_
0 0Q `7S00 Lot No.
'05% 1,0 A4—Av— Block No.
Right Side: Left Side:
'T I E DO1a ICJ YINV a &L, L H U i'�li 3
( (L--V9 J�) -Dccv�-� c- qe4kd eiew- uh�6 116
AaOHVAC orK co eperrormea L] GasTank unaer tE]Gas Piping e`K "apply-
a� Shutters a Windows/Doors
Electric [4 Plumbing Sprinklers Generator F p Roof Roof pitch
Total Sq- Ft of Construction: S . Ft f First Floor:
Cost of Construction: $ ILt oy Utilities: 91Sewer ❑ Septic Building Height:
OWNER/LESSEE h',
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CONTRACTOR '
Name +i'_wesV� o��l?
lQ i P�fLl�
Name: C
Address: V-v '0016k
oean 6100WX64
Company: �LjJ VIA,
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City: S. hid!
State:'=1 i
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Address: 14 0 P (�--�'�
City: i A iCir- lM
State:-J—FL
Zip Code: Fax:
Phone No.
Zip Code: 3 -2--7 L41., ��Fa��x:
401-
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail: \ft,`e ,S cl.`
a 1i ` f` CJ
from the Owner listed above)
State or County License: -r 'N O'Z 542W
I if value of construction is 52500 or more, a RECURDED Notice or Commencement is regwrea.
:SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION ,
DESIGNER/ENGINEER:
_ Not Applicable
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:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and mstauation as maicateo.
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
1
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signatufe of Contractor/License Holder `
STATE OF FLORIDA
STATE OF FLORIDA��
COUNTY OF*
COUNTY OF
The forgoing instru nt acknowledged efore me
b fore me
TheMONO
thisaw
this day of 20by
v\L 1
_E)1
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pr
Prod'
�,�� TERESA BR7YA
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f ;c Commission
M Commissiovo
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=p M Commis naasn
(Si ' ° 1Votary PuMbIstfi&.012IqQQJa )
(Sig t , t �tary Pubfta )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
_
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17