HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICA4E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
--is OWN&
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34.982
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 IMPROVEMENT LOCATION: P
Address:
Legal Description:
iv�_ Uo�
u
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: _! Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additiq,wn work toa er orme un er t is permit— c
HVAC E] Gas Tank E]Gas Piping
11 Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction: 15UT?� 00
Cost of Construction: $
rr• r
_ Shutters L Windows/Doors
ElGenerator D Roof Roof pitch
S Ft. of First Floor:
Utilities:0 Sewer O Septic
Building Height:
I
OWNER/LESSEE: I CONTRACTOR: �
Name I
-'
Address;
D ely
City:( V/
State:
Zip Code:)t Fax:
Phone No.
LP10_gC)4__4Lf q
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: U0,
s�Ikff V ,iti✓I
Company:
Add ss: L?� 1:9Cl ' v�
City: 1 LA-t'V-\ State _�Iz_
Zip Code:
PhoneNo.
E-Mail:i✓� l.Liit1 `fbt'�f�rc Z� t��_J
State or County License: __ w
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:
I
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 work or recording our Notice of Commencement.
s
_ Signature of Owner/ i e Age t
STATE OF FLORI A
COUNTY OF /
Signature of Contractorjf.Cens older
STATE OF FLOE }A
COUNTY OF
Theforgoing instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this �C� day of 20N by
this day of 20 j_)_ by
rN f) 1 ou
(Name of person acknowledging)
(Name of person acknowledging)
(Signatu of tart' Public- State'of Florida )
(Signat e of 74otary Public -State of Florida)
Personally Known ✓ OR Produced Identification
Personally Known -,---CR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No.O (Seal)
Commission No.�Ty 0830(240 (Seal)
JOYCE MIC
r' JOYCE MiCHAEA]
+: MY COMMISSION # FF 083006
€` EXPIRES: April 25, 2018
Revised 07/15/21014 ti'9 r' F e? Bonded Thru Nolary Public Underwrters
,+ :rc MY COMMI551CN # FF 08300�i
� EXPIRES: April 25, 2018
s,;�j 4+= Bonded Thru Nota y Pun !Jnde'_niprs
SEA TURTLE
MANGROVE
I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
REVIEW
REVIEW
INITIALS