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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED IN Or_ Date: 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 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROV.EMENT,'LOCATIQN Address: Legal'Description: Property Tax ID#: - - Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK N &AL, UWtAJLU� 00C1 k -4t, CONSTRUCTION INF.ORMATI©N Y s • Ft: * ,,,�' r„ t �, Additional work toe e V orme under this permit- ec c a appy: HVAC Elas Tank []Gas Piping OGenerator Shutters ❑Windows/Doors Electric ff Plumbing Sprinklers ❑Roof Roof pitch Total Sq.Ft of Construction: SFt.of First Floor: Cost of Construction:$ ``rj ( QUtilities: _Sewer Septic Building Height: OWNER%LESSEE �} 'CONTRACT R ` Name 44.R, 6 Vk6 DePaMA LC- Name: Address: Company: City: State:rA Address: Zip Code:. Fax: City: Stat 7 1 Phone No. U - Zip Code: 7 Fax E-Mail: Phone Fill in fee simple Title Holder on next page(if different E-Mail: QDV iv &oil, 6o ry'l— from the Owner listed above) State or County License:n�Q- 7021 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. x s SUPPLEMENTAL CONSTRUCTION LIEN LAVA 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: 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 rk or r ecording your Notice of Commencement. X /Z 92��', S Signatur f er/Lessee/Contractor as Agent for Owner `Signature f Contractor/Lt se Holder - STATE FLORID STATE OF FLORID . COUNTY OF lam( COUNTY OF � 111 A'A. The f r oing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of - 20 Qby this day of 20 �by (Name f p4soli ac k ov,,iect ing) '. =d�sonng) -� (S gn ure gLRotary ublic-State df-Florid-a) ignature of Notary ub'c-State of Florida) Personally Known OR Produced Identification P sona�Kno OR Produced Identification Produced Tpe otion Produced Commission No G (Seal) Commission No. Py M. IBERTYA.KING :+: "MISSION k EE 877248 = • a,€ EXPIRES:May 4,2017 Bonded Thru Notary Public Undenu t m Notary public State of FbritJe Revised 07/1 Karen F Wilson My CQmfh$Sion FF 928291 Oo p V 6ON REVIEWS FRONT ZON VISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS