HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
J._
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 LIX
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 775
C
Legal Description:
Property Tax ID #: -700 - 00YO -000 Lot No. 7...7�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
C DETAILED DESCRIPTION OF WORK:
N) QCkAM eM � of So'� C>- � C4f_'1' c WQ ve_� Ju,2k,
CONSTRUCTION INFORMATION:
CONTRACTOR:
Name t
Name:
Additional work to b rformed under
HVAC Gas Tank
this permit- check
❑Gas Piping
all that appy:
Address:
City: o S lt,e State: L
Zip Code: 3q Fax -
Phone No. -77.2'%77-0C?/
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: �k We h 71 C�;• C%Cil✓�
State or County License:CR� %Li, 0,
Shutters
Windows/Doors
Electric
Plumbing
Sprinklers
Generator
F]
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 300
Sq. Ft. of First Floor: _
Utilities: 1-__1 Sewer ❑ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t
Name:
Address: r Q�-ujC C�'
Company:
City: p 5)-- State: 1_�
Zip Code: ��j�,��c> Fax:
Phone No.
Address:
City: o S lt,e State: L
Zip Code: 3q Fax -
Phone No. -77.2'%77-0C?/
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: �k We h 71 C�;• C%Cil✓�
State or County License:CR� %Li, 0,
. VC UU %J, wnau uLuun n ?cauu or more, a KLLUKutu Notice oT commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 work or recording Your Notice of Commencement.
Signature of Owner
r as Agent for Owner I Signature
nse Holder
STATE OF FLORIDA ' s STATE OF FLORIDA (,
COUNTY OF COUNTY OF
The for ping instru n was acknowledged fore me
this day of 20 /by
(Name of person ackn_pwlesi&j )
�Klgnature ofA94ry70R
State of Florida )
Personally Known Produced Identification
Type of Identification Produced
JOHNATHAN RAYMOND FITaRAT4"
My COMMISSION # PF233682
53
The forgoing instrume t was acknowledged Wore me
this 7day of e1V14-9' , 20 by
(Name of ge9soy� ack wle g' � /
gnature of�d'o� Publi tate of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Comm
-44 i � 3ya-i7' S3
My COMMISSION # FF233682
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS