HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date:, Permit Number: I �v ®� a
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Building Permit Application Is
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Planni; g and Development Services st.
Buildi g and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phonl: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
II
PERIVIIIT
APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I
, :PROPOSED
IMPROVEMENT LOCATION:
Address:
Legal Description. — ( I ( 0"�
Propertil Tax ID #: ��n�! �' I Uc� I r U O O d Lot No.�
Site Play Name: ��lY _C-, Block No.
Project Name: ,F
Setbacks Front Back: Right Side: Left Side:
I'I
:DETAILED DESCRIPTION"OF;WORK:'
-
COIN S�
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H
_ E
Total Sc
Cost of
RUI ION.INFORMATION:,
al work to be e orme a under is permit—c ec apply:
AC El Gas Tank ❑Gas Piping _ Shutters
ctric 19 Plumbing Sprinklers Generator
Ft of Construction: Q oZ 5D S . Ft. of First Floor:
instruction: $ 0_00 Utilities: WSeptic
Windows/Doors
Roof Roof pitch
Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name
Address:
City:
Zip Code
Phone
E-Mail:
Fill in fell
from th
Name:
Company: ��
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lr' State:7b
: Fa
o. �- � (�
Address:
City: State
Zip Code: ` Fax:
Phone No. �2
simple Title Holder on next page (if different
I Owner listed above)
E-Mail: 1 _
State or County License: l7 3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL
CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER:
Nam
Address:
City:
Zip:
_ Not Applicable
I�
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
1'1 State:
II Phone
I I
City: State:
Zip: Phone:
FEE SIMPLE
Name?
TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
city. h1
city:
Zip: 11 Phone:
III
Zip: Phone:
OWNE / CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify hat no work or installation has commenced prior to the issuance of a permit.
St. Lucie lCounty makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure 11. 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 accorc ance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follow) ing 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 ay resu
I:lt in your paying twice for
improvements to your property. A Notice of Commencement must reco ded and posted on the jobsite
before he first inspection. If you intend to obtain financing, consult IM le n er or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of Owner/ LesseETCottractor as Agent for Owner Signature of Contract Licd rise Holder
STATE OF'FLOR ! STATE OF FLO
COUNTY OF J COUNTY OF 1/�1.
The forgoing Instr ent knowledge�,t%fore The f rg ing inst um nt w c owledged�b,�fore m
this k day of 20n by this 7day of 20 \lbv
EJ1 `Y_7TC�—'r'c` W i�—
Name of pers making statement Name of per maki (g tatement
Personally Known OR Produced Identification Personally Known OR Pr duced Identification
Type o Identificatio Type of Identifi , tion
Pro uc�d Produced
1)c
)A 0, 01,�
(Sign Ire
of Notary P is (Signature of Notary ubli -
t►ava"'''• SANDY CANNON ,+; x;r+Up,+
ublic-State of Florida SANDYCANNDN
Commission No.� ' ' )iblic-State of Florida
�. (gyp . Commission No. P
Commrssion>eGG36068 �Commission#GG36068
' �koaPt� F My Comm, Expires Jan 27, 2021 c r� My &ffi is Expires Jan 27, 2021
REVIEjNS I COUONT I NTER RENING VIEW W I SUPERVISOR REVIEWI PLANS I REVIEW VEGETATION I S REVIEW I MANGROVE
DATE
RECEIV D
DATE 1,1
COMPLETED
Rev. 8/2/17