HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date: Permit Number: l
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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 {N�PR01/E�T 11 C, O:N
Address:
Legal Description:
Property Tax ID#: t 00 Or 00n Lot No.
Site Plan Name: l d 1 Block No.
Project Name: in f 0 r 4 t
Setbacks Front Back: Right Side: Left Side:
DE A{LED DESCR'IPTI®N OF ®RK:
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CO'NSTRIJCTlON l�N'F®RIVIATI®N:
rtional work to be pertormed uncler this permit—checK all that appy:
echanical _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:
®UI/NER/LE�SSE'E0 r t L L C®NTRAC1"O:R: x
Name Name:c5. eev , S
Address: � Company:u.
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City: .i nrur4 State: Address: Q�a IVW 102--
Zip Code:--)LO� Fax: City: 0 ke-e('1�l State:
Phone No. �7 Z- �� J s� � Zip Code: Fax:,&0 ?- CA,!r
E-Mail: Phone No I`o 3 r �7 ll 7` L(733
Fill in fee simple Title Holder on next page(if different E-MaiiC lS in L pkil y,4,,-
from
ds ,vfrom the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Ll I III Ill! 11115
SUP, L.ENIE T/.!,►L CaNST'R�UCTIaN L�E'N LAUV IiN�FC?R�MATtON: t 9
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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
commendnR work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA Q
COUNTY OF C '� COUNTY OF
The forgo' g instru men nt was acknowledged before me The forgoing instruwas acknowledg efore me
this J�2y of 20L by this_;):20ay of 20 by
(Name of person acknowledging) j (Name 61 person acknowledging)
(Signature of Nota ublic-State of Florida) (Signatur of No ry Public-State of Florida)
Personally O Produced Identification Personal K�1�1'K • OR Produced Identification
Type of Ide t� ,"���"' . j'' ANG Type of i
Produced _`''`�1•`�= E 9/4�FF Produc d= .- o
c, `` ,• Commission 5r�eOf Florida <<_ p a°;'M Commis ,Srat Ff
P°C MY Com #FF �� � Commission IV"o. o YCom s/0� FFe�/F/ofr
Commission No, :.;:;, ' m.Ex
�ondedthrou Pres Ma - irhrou£ Ire, 234j3
9h National No27 2019
aryAssn. 9hNalioga ay?�20
YAssn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE- MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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