HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ll
Date: 02 < 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 Residential
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PERMIT APPLICATION FOR:
PROPOSED,INPROVEMENT.LOCATION fr '
Address:
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Legal Description:
Property Tax ID#: (rLV • Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK 'I''E
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CONSTRUCTIONhIR1FORMATION ,
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Additional.wor to ape orme under this permit-checFall that apply
echanical _Gas Tank —Gas Piping _Shutters I _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor,:
Cost of Construction:$ Utilities: _Sewer _Septic I Building Height:
ES Wow CONTRACTOR,
Name L n ii • Na.me.:,�.r..ko _ est
Address:..7s6 '_Ga psi e --Company i� i 1c.S'I"0E { k.,--r..6e– Cars
City: /�� Pl��� State: L 'Addres/s:'!N(J M
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Zip Code: N9X- Fax: City: Vey-o 6eQ,4 F' Stater
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Phone No.(7-7Z �.���` �� 7 Zip Code: CFO�61?_ '471 k Fax:
E-Mail: Phone N _770)7/7'' -7716
Fill in fee simple Title Holder on next page (if different E-Mail C�{.;rde)cs Z 74,_) (le 4o.c-d/,A
from the Owner listed above) State or County License �i������c5�°,�a,
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ,
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SUPPLEMENTAL CONSTRUCTION LIEryN LAVV INFORMATION
DESIGNER/ENGINEER: _Not 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.
ature of Owner/Lessee/Agent Fg at re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 7a _ r_.I , COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Q day of 20 bythis a day of n 201 by
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(N djof person acknowledging) (Name Iperson acknowledging)
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nat re of Notary Public-St a of Florida) (Signature of Notary Public-Stat f FloridaIdA )
Personally Known OR Produced Identification Personally Known OR Produ ed d
Type of Identification Type of Identification UssyAnlONleuO{1eNU6naUlpaPUog
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REVIEWS FRONT "'SUP'ERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014