HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: TIrL�-ii�, �( Permit Number: /U/�" UL
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I MWESsmawBuilding Permit Application 6�'�� �[�
Planning and Development Services �t
Building and Code Regulation Division Lucie County
2300 Virginia A Ienue, Fort Pierce FL 34982
Phone: (772) 4.62-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
:,"PROPOSED IMPROVEMENT, LOCATION:
Address: "
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Legal Description:
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Property Tax ID #:
J3 '-
00 '
Lot No. _
Site Plan Name:
Block No.
Project Name:
Setbacks Front
Back:
Right Side: Left Side:
DETAILED DESCRIPTION"OF WORK
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CONSTRUCTI,QN'INFORIVIATIO.Nz=.`...
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Additional workito be peSrormed under ffG
rmit— check all apply:
OHVAC _ Gas Tank as Piping _ Shutters ❑ Windows/Doors
0 Electric 0 Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer 0 Septic Building Height:
OWNER/LESSs
RACTOR:
Name e
Name: VII-tdeoriv
Address: L (
Company:
GlL S
City: PAW.,Sta e:
Zip Co e: Fax*
Phone No. �
Address:
City: A IIVI I
Zip Cole: �1
Phone No. 17i
E-Mail: V 1. q
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0011'
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Fax: 0 17� I.i ,
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E-Mail:
Fill in fee simple7itle Holder on next page ( if different
from the Ownerllisted above)
State or Couhly License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTIp I'EN LAV1/'JNFORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: 1 Phone
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Address:
City: State:
Zip: Phone:
FEE SIMPLE TeTLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 iork 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 concurren'cy 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 vour Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Hol
STATE OF FLORID A
STATE OF FLORIDA
COUNTY OF C
-l—�Y1
COUNTY OF V-An A-\
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day oft)j-zio.,r,���
, 20 16 by
this ILA day of � 7C,,�,? ,�,+ , 20A by
Name of person
aking statement
Ne of pers making statement
am
Personally Known V
OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
n.. AA A,
Prod d
0a,
(Sign ure of Notary Public- atrid' Jenne-1 Gl
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na re of Notary i fate e
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Commission No.
a=EOMMISSION # GG2
mission No. • = COMMISM4 MGM
= " EXPIRES: Augost 13
2022 �.. , EXPIRES: AugUSt 13,Bonded 2,+022
ru Aaron
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17