HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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®®� Building Permit Application Ae"Itt. ?019
lanning and Development rvices st a county epa ent
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uilding and Code Regulation on
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentialy
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: .E i 1 -eZ / PSG zi 3 R 3
Legal Description: #ri7Ded1 /ZrV o,^ CS%�r�S 84-1< �T Lb rog Y[oU — ' 91el
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Property Tax ID #: J 3 V27 " 70 / •- 400// — 000 — -2- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: SCANNED
BY
aDETAILED
DESCRIPTION°OF WORK
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INFORMATION
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OHVAC f] Gas Tank ❑Gas Piping _ Shutters 0 Windows/Doors
11 Electric ElPlumbing Sprinklers Generator D Roof Roof pitch
Total Sq. Ft of Construction: ezoo sj} ,rr S Ft. of First Floor:
2 LFv o
Cost of Construction: $ Utilities: Sewer 0 Septic Building Height:
OWNER[LESSEE
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CONTRACTOR .
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Name: O
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City: T`✓/ S/Nh1 L6P1� State: _
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Zip Code: Fax:
City: e State:
Phone No. '77 Z 214 79VI?
Zip Code: Fax: �!
E-Mail:
Phone No. 00
Fill In fee simple Title Holder on next page ( If different
E-Mail:
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION'LIEN,LAW
INFORMATION:
DESIGNER/ENGINEER: (, _
Name:
Not Applicable
MORTGAGE COMPANYE!�", _
Name:
�'_,Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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
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
commencing work or recording our Notice of Commencement.
SI nature of Owner/ Lessee/Contractor as Agent for Owner
Sr natu ntractor/License
STATE OF FLORIDASTATE
OF
COUNTYOF��lov/
COUNTYOF
The f� in was acknowledged before me
The forrgoin ntrpe was acknowledged before me
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this' day of ,20_Ub
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ginstru
this T day of 20A by
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Name df person making statement
Name Bf person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(SlIgnerfure bf Notary Public- State of Florida)
(Signatu7ee of Notary Public -State of Norida )
Commission No..,ac.LSONA INGRAM
Commission No. ..�r�crSe
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DATE
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Rev.8/2/17