HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l�
Date: Permit Number:
—r
.,� RECEIVED FEB 0 6 2017
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 1
PROPOSED fM°PROVEMEN°T'LOCATION`:
Address: 1 sa 6'ZQ 04
Legal Description:
Property Tax ID#: S4 10-50 - Q'�0- (10-S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION -OFWORK:
Lg3 S
CONSTRUCTION,I;NFORMATION.
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: }, SFt. of First Floor:
Cost of Construction:$ / C9 8 UtilitiesInSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR: ,
Name V L U Name:
Address: ilk Company: i (_
City: State. Address:
Zip Codei5 �2. Fax: City: _G'(,� State: r r'
Phone No - Q��-� Zip Code: ��(� z- Fax: [ C� - YU f
E-Mail: Phone No. IT
Fill in fee simple Title Holder on next page (if different E-Mail: C -L�1
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
}
SUPPLEMENTAL-CONSTRUCTION LIEN -.LAW 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 thepermit 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.
s
Sig at a of Owner/Lessee/ ontractor as Agent for Owner Signature 1ZS
tracto /License of er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF k 1-11)C"NCOUNTY OF Sk ,
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this o day of 73�� , 20 )il-by this day of 9ti\ 20 L-L by
� Q""tt Sywd�v u I':\ !d, -t-'s w..a.�-w 1 a
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida ) (Signature of Notary ublic-State of Florida )
Personally Known OR Pro iced Person i ation
Type of Identification Prod IE 0111 Type o ion PrB=.
29
S1oN# _, MY COMMIS �
OR.—AMK CpM tA1S mbar 16.202 _r• += bei 16,2020
Commission No. p�PIFt�S`c ebtt�Uederv6las Commi ,r ,o, pubtkUnaor�r Bal
:••, eS Bonded N
Revised 07/15/20 4
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS