HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (/�t �5 /
Date: Permit Number: /d lJ2 ` 00 `' 1b
• Building Permit Application
Planning and Development Services O
Building and Code Regulation Division 8
vl/
2300 Virginia Avenue, Fort Pierce FL 34982 b,0 S'
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: �%� !l �5�3()-Odb l%��i�� Lot No.
Site Plan Name:
Project Name:
Setbacks Fronts! 1 Back:fel_ Right Side: ! 1 Left Sider
DETAILED DESCRIPTION OF WORK:
Block
A4-PA i � k g4.!-i Lacs WORPO1 F"Owe6 jig f,46e a trR v[4PIW- XWOWeD OVAP gX
14VP J 011,46X I) - APePDXiNAMP/ s9C" a* vRerM-W F-&Mm-P'P F*F*0 4-
CONSTRUCTION INFORMATION:
Additional work to be nertormed unclert
11HVAC Gas Tank
ispermit-check
❑Gas Piping
all that appy:
_Shutters
Windows/Doors
11 Electric 0 Plumbing
Sprinklers
ElGenerator
11 Roof Roof pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
0 OSeptic
Cost of Construction:$ ���"�. //
Utilities:
Sewer
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address: A. 10Company.
City: State:wp/J�-
rtt'rI_
Zip Code: Fax:
Phone No.
Name
-
Address: -
City: State:
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next pag if different
from the Owner listed above)
E-Mail: 1
State or County License: Z
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
of Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/.60fdfPA"QR 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 inspectiop�tt If you inteN to obtain financing, consult with lender or an attorney before
commencjAg work or reftding Your 140tice of Commencement.
�A e J-4A ^ �
� A I i
4 a
Signatu e of 15caKerT�s t or wner
Signature of Contractor/License Holder
STATE O M C Koseitf
STATE OF FLORIDA
COUNTY OF�gpc�P n
COUNTY OF
The fprg�ing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this dd day of .b�T' ri� 20 � Q by
this day of , 20_ by
Pe-4{e� Mi Il'e
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced Ml0. JIC 1 V!S I,twn-,P
Produced
(Signal re of Notary Pub
-
(Signature of Notary Public -State of Florida )
ALYSSA 0. AVERY
Commission No.
(Sealpotary Public
ommission No. (Seal)
Massachusetts
_
-- — --
„w Commission Ecplres May-25, 202
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17