HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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 IMPROVEMENT LOCATION:
Address: ( r10r( lJWv
Legal Description: 0 a.16"' f' t/"/t!! i-e—
Property Tax ID#: LN" F,257 C) Z n JU Lot No.7_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDf7 DESCRIPTION OF WORK:
V C
CONSTRUCTION INFORMATION:
Additional work toe performed under this permit—check a appy:
-HVAC E]Gas Tank ❑Gas Piping _Shutters �1 Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Z— �� Utilities.. Sewer Septic Building Height:
OWNER/LESSEE: ; . CONTRACTOR:.
Name_TJ
at, o 4- Name: Lic }-T�>
Address: u I wnf+�, V Company:,�_O (L
City: State-)�Y Address:
1
Zip Code: 1 0 �3 Fax: City: ��iio,�� Stater
Phone No. 5-Y 30 SA Zip Code: 3LL 79 I Fax:
E-Mail: Phone No. -I L (_71%_1
Fill in fee simple Title Holder on next page(if different E-Mail: CA(,-bv tc--.'S �-�=✓��
from the Owner listed above) State or County License: Z,3 a 6 3 _
Uc 15b9714
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: i Not Applicable MORTGAGE COMPANY: _LA,,Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: blot Applicable BONDING COMPANY: t 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 1 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF HaOIn COUNTY OF MaY*K)
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this 21Nay of '0(CCm bbl' 20 LILby this day of 0rC CCvmlx., .20 l�- by
( e of person acknowledging) ame of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known `- OProduced Identification Personally Known ----0—R-'Produced Identification
Type of Identification Produced Type of Identification Produced t
Commission No. r— 131 J.3 4P (Seal) Commission No.EXE,Q (Seal)
SHAWNA M.HOD E S SHAWNA M.H GE
W) P1401 eel NOT
STATE OF FLORIDA STATE OF FLO DA
Revised 07/15/2014 %. .V'sw ComnW FF131&16 W-11C FF131Ex 8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS