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
Commercial
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i ST. Lucie Count)
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of link /^
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Address: YIYI MQ116Y-L4 04,
Legal Description: AlnAk 'fork rs-64rc -51A Lal .25 Ac.) L LY,91-25;
Property Tax to#:3Lio9-503-[7oa8,-noo-o Lot No. as
Site Plan Name: V/rM Block No.
Project Name:
Setbacks Front $ 5 Back: 70 Right Side:10 Left Side: .55
J�DETAILED.DESCRIPTION OF.WORK
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CONSTRUCTION' INFORMATION: .
Gas Tank
Electric "Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ aaJY
nit— cnecKau appiy:
Piping _Shutters Windows/Doors
nklers Generator 11 Roof = Roof pitch
S Ft. of First Floor: _
UtilitiesSewer 0Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
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Name: T6Cie Ar
Address: lVgl /i%Cj
Company: F %6 e ikli- 4FAqkW1
City: &f9. L. .c. State:E(�
ZipCode:349V— Fax:
Phone No.
Address: Mv5o ,S • aW
City: rf State: Wit,
Zip Code:Ati 9 9 t-( Fax:
Phone No. 77 ?-7 I - 1/ol7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:Irv-0
State or County Licen�a.
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
J'SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION: -
Not Applicable I MORTGAGE COMPANY: _ Not Applicable
IVd11IC: IYa 11 IC. -
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name: Name:_
Address: Address:
Zip:
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 work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or ancovenantsthat 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 Afwou intend to obtain financing, consult with lender or an attorney before
commenrina work or rerr66rdir E vour Notice of Commencement. A l\
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f Owner/ Lessee/Contractor as Agent for Owner
Signatu40'OF
Signatur of Contractor/License Holder
F FLOR1 IDA
STAT OF FLORIDA
. LL I
COU TY OF MaMI A/
The f going instru ent was acknowledge efore me
The forgoing instrument was acknowledged before me
this day of 20by
this _7 day of \ �i.. 20-Cby
t
-cWE-
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known Ot-- OR Produced Identification
Type of Identification
Type of Identification
Produced
I LQ
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. ARE IELSEN
Commissi Y ' AM ROBE J
State of Florida -Notary Public
tale of Florida -Notary Public
�= Commission # GG 201318
Commission # GG 207484
's �c My Commission E '
'PSCa"
June 12,
2022
arch 28. 2022
REVIEWS
PLANS
NGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17