HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /�
Date: Permit Number: l_1 1 osq(f
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V 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 IMPROVEMENTLOCATION:` tea,
Address: 0S" -j -eS V f 1✓`1 J 0L. A Pierce IL 3q,
Legal Description: -,ib -F(?biM IJ L-. n e- Wil- q rvn -4
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Property
-Property Tax ID#: .'3L4 g5 OI Lot No.
Site Plan Name: Block No. v
Project Name: r�
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Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK: - e r;
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CONSTRUCTION INFORMATION —
Additional work to be nerformed un ert ispermit-check all t=ap_p1y.
HVAC Gas Tank []Gas PipingOGenerator'
Shutters a Windows/Doors N
Electric ElPlumbing Sprinklers Roof ) Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTORq 4A
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Name SGh Name:
Address: Company: LAIL C%t
City:7gQr+ Pj'{'r-Ce State:-4Z- Address: 013 d rM y4
Zip Code: %311'q&- I Fax: City: Po(+ 4- SIA
State:
Phone No. 1'7 a - LI WtZ)- I L L4 a Zip Code: +141, Fax: 1)r]R-aarl-r7jgLl
E-Mail: 0-f-r-0 C�h r � -@� 4- 1. G�v--) Phone No. '7�1'. - 3 q!J t1 Icl 5
Fill in fee simple Title Holder on next page(if different E-Mail: S� I v, c;o- rocFt'n (�;)'-(a_V1,zyo. e.6�
from the Owner listed above) State or County License: CCC 'I 33 0 K I L`
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPP:LEMENTAL'CONSTRUCTI'ON LIEN,LAW INFORMATION: l:
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 Count 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.
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SIgnature of Owner/Lessee/Contractor a Ag for Owner Signatur66f ntr ct r/License Holder
STATE OF FLORIDA STATE STATE OF FLORIDA �_�
COUNTY OF S4 �L'-f`e_ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this d-) day of I CIn 20 11.by this t99 day of X14 r1 20 J by
(Name of person acknowledging) (Name of person cknowledging)
(Signature of Notary Public-State of 5orida) (Signature of Notary Public- tate of Florida)
Personally Known OR Produced Identification Personally Known e ntification
Type of Identification Produced '"l'L- I Type of Identification Pro -
Commission No. ' ``)"n CONSCommission No.
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10
JL4o�3'98 U153 S September 16,2018 Sem• 2018
Revised 07/15/2014 FbrMallotarygee
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS