HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 9
Date: Permit Number: 110
4D
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: �?
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DES,CRIPTIONOF WORK �� ' �g � � �
CO
7Y�j '1 \'4(N 4,NSTRUCTION;INF.ORMATION `, fr'1=
Adclitional kwork to be ertormecl under this permit—check all appy:
HVAC Gas Tank E]Gas Piping MGenerator
Shutters Q Windows/Doors
Electric LJPlumbing Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Utilities:liSewer Septic Building Height:
OWNER LESSEE `
CONTRACTOR TM
...ir„S
NameName:
Address: Company:
City: + State: Address: e +
Zip Code: Fax: City: 0,�1 Q, State: J
Phone No. Zip CodeL ��f' Fax: `��
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: a D4(f 40
from the Owner listed above) State or County Licensell_:R, -7491
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTA�LtCONSTRUCTION�LIEN
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 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
commWvqng work or recording otice of Commencement.
s
ignatur of O ner of essee/Co dor as Agent for Owner Signature ontra or/Licens Hol er
STATE OF FLORI ✓ STATE OF FLORI
COUNTY OFi,p–L'L COUNTY OFGO
The forgoing instrurpnt was acknowledged before me The for oing instr ent was acknowledged before me
this day of Rwj 206_�L_by this day of eJ& 20 1 by
(_ 4V V-)kv A 17'1 Azjrq�-o
(Nam f pe son acknowledging) (Name erson acknowledging)
Sign ture of Nota blic- ie of Flori a ature of Notary Tlc- to of Florida)
Personally Known OR Produced Identification Personally Known roduced Identification
Type of Identification Pro Type of Identification Produced
ZORP
LIBERTY A.KING
Commission No. =* = LIBERTYAi(ING
MY SION#EE 877248 Commission No. ;. MY ION#EE 877248
XPIR S:May 4,2017 4,2017 Bonded Thru Notary Public Underwriters L1, d: Bonded ThruRNotary PubllC Underwrite.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS