HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED v�
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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: To Select from dropbox, click here
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Address:
�csai t`)tSCiii3iivi�: S 4 - 12 3333 - 7u-7
Property Tax ID#- 14ILE- 901- 019)3 -()m' Z Lot No.
Site Plan Name: Block No._
Project Name: ..
Setbacks Front Back: Right Side: Left Side:
DETAILED
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CONSTRUCTION INFORMATIOW :..-
Aciclitional worK to ewe orme un ert is permit-check a appy:
�:iuA� I`�IvasTark ❑vasPsp;^b _Shw�tters al,":,ndoA�s/Joo:s
Electric 0 Plumbing Sprinklers El Generator Roof
Totai Sq.Ft of Construction: S�Ft.I Of First Floor:
Cost of Construction:$ ��� Utilities:Ll Sewer ElSeptic Building Height:
OWNER/LESSEE:..'-- CONTRACTOR
Name eC'.wi Name: p rnue[
Address: Company:m Or D14h rwgj e_ QSf-
City: State:EL Address: S. marfA� 4mokutf-
Zip Code: _.._ _.. _. Fax: .. City:_. _0_ � _ .[[iiii__. State:.
Phone No.�43—a to— Ln�� 0 Zip Code-,344 06 Fax: 772-Wo E��-tM5_
E-Mail- Phone No. - -I
Fill in fee simple Title Holder on next page(if different E-Mail: A VOL
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from the Owner listed above) State or Cqunty License:
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If value of construction is$2500 or more,a RECORDED Notice of CornmencerneOW is required.
SUPPLEMENTAL CONSTRUCTION-LIEN LAW INFORMATION: --
DESiGNER/ENGINEEIR: —Not Applicable - MORTGAGE COMPANY: Not Applicable
Name: Name:
Address- Address:
City: State:— 1Ci t V: State:
Zip: Phone: Zip. Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY-: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip:
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 n ielcoun
conflict no representation that is granting a permit will authorize the permit holder to build the subject structure
whichis with aapplicable 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%vill,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 tender or an attorney before
commencing work or recording your Notice of Commencement.
S�'igrfafture of Owner/Ag ntJ Lessee SEg afore of Contractor/License Holder
STATE OF FLORIE�A STATE OF FLORI!A
COUNTY OF COUNTY OF
The forfging instrument was acknowledged before me The for s!Tment was acknowledged-3- going in iowledged before me
this , day of A 0 Lt C,nA-, )JM by this day of r .f0i LL0_r(A-
20Wby
(Name of person acknowledging) (Name of person acknowledging)
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(Siinature of Notary 0 (tig'n-aituire—of Notartfub Sta rimi -W"/'
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Personally Known "' lrotl*cf� -on Personally Known#ficati
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Type of Identifilcatio Type of Identification P ducdl
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Commission No. Commission No.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPEPVISOR PLANS VEGETATION SETURME NIA
WGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETE