HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t
Date:
- 7,/� Permit Number:
1.
Building Permit Application JUL 2 7
201
Planning and Development Services
PE [TT iNCa
Building and Code Regulation Division Si, Luci 'ounty, F.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LO ATION:
Address: Q(JQ S 6C.A�I.,
Legal Description:
Property Tax ID#: - (7ri Lot No.
Site Plan Name: Block No.
Project Name
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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'000011:W i✓ AL""q71
CONSTRUCTION INFORMATION:
Additionalwor to e per Orme un er t is permit—c ec a t at app y:
VMechanical _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:
OWN ER/LESSEE: CONTRACTOR:
Name ✓t ' Name:
Address: ocici s �A� V• , ' Company:
City: JP,V1S2+1 qa State:6 Address: S'i✓ e f
Zip Code:j�� Fax: City: /State: �L--
Phone No. 77 a— 2�I Zip Codes �{ � Fax:
E-Mail: Al//q- Phone No 17?3. J)'V- ?qi M
Fill in fee simple Title Holder on next page if different E-Mail "A"se
from the Owner listed above) State or County License Zjf.�� C2
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: w 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.
ice_
Signature ofOwner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF •� Ct,}1 COUNTY OF ,A . I l IQ,I i,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Qq day of�_ 20_L6 by this a day of V 20 1(P by
6g&I
(Name df person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida } (Signature of Notary Public-State of Florida } /
Personally Known OR Produced Identificationy1 Personally Known OR Produced Identification v'
Type of Identification Type of Identification
Produced Produced "El. __I
t i `Sep; Corrjmission No,
Commission No.
1 i<`
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev,7/2014