HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number;
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
PERMIT APPLICATION FOR:
Address:
Description:
RECEIVED
NOV 13 2018
ST. Lucie County, PertA'!!M9R
Commercial Residential Y
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Property Tax ID #: `I L+ �4 o I (--) I - o Block No.5
n 1) - Lot No.
Site Plan Name: V.�E��Z �.` \xey-
Project Name:
Setbacks Front Back: Right Side: Left Side:
J
NSTRUCTiONIN��3Rit/IATON'
itiona workt0
.A.t.:
e e orme un
El
,4,..«
er t Is permit — C eC a app y:
❑_ HVAC
Gas Tank
❑Gas Piping _ Shutters
❑ Electric
0 Plumbing
Sprinklers Generator
Total Sq. Ft of Construction: —I —a 1% SgFt- of First Floor:
Cost of Construction: $ (g hOU• O U Utilities: 0Sewer 0Septic
Name \
Address: PA3fn� Vi1xc- I-rNt,
Cityi�h� c�5l�r 'S�\CA State: -
Zip Code:01 Fax: ----
Phone No.
E-Mail:
QWindows/Doors
® Roof FIT—]
Building Height:
Roof pitch
Name: �. 1
Company
Address:%41EL\ �,IPF \kiir'R -
CityL-\o NS Je 0. State". —Al -
Zip Codeai-L !ar Faxi"i7.-C1-61i-140%4
Phone No. ii-a.— C�ad - l O 0%q
Fill in fee simple Title Holder on next page (if different I E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: A Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
State:
City: State:
City:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: X 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 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
structure. Please consult with your Home Owners Association andrreviewyyour deed foroany restrictions which may rict aprohibit such
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 our Notice of Commencement. �1
SignKure of Owner/
as Agent for Owner I Sign5Yure of
Holder
STATE OF FLORID STATE OF FLORIDA ��?+
COUNTY OF � - )-()C1-z. COUNTY OF
The forgoing instrume t w s acknowledged before me
this / day of �' y 20 IV by
J'r'l_S LI�3 SPn
Name of person making statement
Personally Known_ OR Produced Identification
Type of identification
Produced
(Signafl"ure of Notary Public- State of Florio)
MARKKEN Sea
Commission #G 99
N� oe Expires September 19, 2021
The forgoing instrument was acknowledged before me
this JLday of .v O✓ 20/ Vby-
Name of person making statement
Personally Known -- OR Produced Identification
Type of Identification
Produced
of Notary Public- State of Florida )
�tgr Pue� MARK KENNY
Commission' S:*" " #GG 144499(
rr VxpEires September 19, 2021
FofF SWedTiuuBudget Notary Sertta
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED
Rev. 8/2/17