HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MU!T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 Residential
PERMIT APPLICATION FOR:
PROPOSED tNPROV.EMENT LOCATION
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Address: �J -(0
Legal Description: ,5, /J/#MUr2 TOCJl� 1/�J�%X705
Property Tax ID#: 23 �o l ����i t7�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.
s OF WORK
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CONSTRLiCT, Q INFORMATION $
Additional work to be pertormed un.der this permit-check a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters =Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of.Construction: Sq. Ft.of First Floor.:
Cost of Construction: $ �� Utilities: .—Sewer —Septic Building Height:
OWNER/LESSEE ;CONTRACTOR
....,; _ .i ,.......' -. •.. ..<: ... ., ... ,x.. x J, a `. ..'..., ...v:
Name 01LUvIhSS�J�.t/TA.. r� Name::; 6,"< e OoLL��L.
Address: 125Z' . ;::n '1; �7a Company:
City: State:�G Address-
Zip Code: Fax: City: Stater
Phone No.7ZL- 6 - �l sZ- Zip Code: 35� Fax:
E-Mail: Phone No 7 Z Z" -3 5(
Fill in fee simple Title Holder on next page (if different E-Mail( re_ /eeZf•��
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTNFORMAT
ION LIEN LAW , IO,N:
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DESIGNER/ENGINEER: _6Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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
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.
1��� ELVIV — (;��
S gnatur of Owner/Lessee/Agent Sig tur of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA '
COUNTY OF • "�- COUNTY OF �
The for o' g instru t was cknowledge b ore me The for oing instrum nt was cknowledge,dore me
this day of 20 y this ay of 20 by
ul�
a(Nameof person ack owledging) (Nameo Pers nac nowledging)
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(Signature of PkpJary Public-State of Florida) (Signature of Notary ublic-State of Florida )
Personally Know OR Produced Identification Personally Known OR Produced Identification
Type of Identifi ion Type of Identificati
"����� Produced
Produced _. `j0. �"� of A M�Hij
Stat
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Notary Rub!!c FF %%tell
-C of Florida Commissi ��rp`A
Commission No -"; 'Ps commisslow ,, . EL
"'•�°"'��,` Bonded h�EhplrFF
es May 2772019 i9! '��;' Comm sstic State� Florida
-W.-IN100.1111im"ll 1919Y ssn. om 4730
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REVIEWS FRONT ZONING SU E ISOR PLANS VE`TAyTIE :, aySliAa,�,.U�K1 E��0 .9 ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIREVIEW
DATE -
RECEIVED
DATE
COMPLETED
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