HomeMy WebLinkAboutBuilding Permit Application r% ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
off. I 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
I.PROPOSED IMPROVEMENT LOCATION
Address: —7 L-A1C Ei U IS 59 7-9-A4 L U dV IT 2 DL -012-�71-b-r. L,U GI i✓
Legal Description: V S v Li l Gi 6 G�6i 7 V�l T 2-0(,,
Property Tax ID#: 34 :2- Soo — a D9 7 —Oars—f6 Lot No.
Site Plan Name: ''//1 fru y n Block No.
Project.Name: IIrU C2 !h AV V',
Setbacks Front Back: Right Side: Left Side:
DETAILEUDESCRIPTION•OFWORK' •." ,
CONSTRUCTION INFORMATION
Additional work toe e orme under t -checkispermit a appy:
❑HVAC E]Gas Tank ❑Gas Piping
In Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers 11 Generator E] Roof Roof pitch
To al Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ � 'b� Utilities:i Sewer E]Septic Building Height:
OWNER/LESSEE `'` `: CONTRACTOR:
Name d- `~JAL Ce, KLL r'Yl M Name: 1 U a C16 a otj__
Address: 2- Company: - Pcn- V ins
City:N AOpo State: IV Address: l6)40Sk)<nII+Tnoyr,
Zip Code:07K& y Fax: City�4-.SA-. Lt,tC.� Stater
Phone No. '17.3-§3y-- 8`Z 1 Zip Code: .341(Tf- Faxes (.-7,7
E-Mail: h Ut )Ca. bjAS pe- h2qlwti ")j/ Phone No. -2 7dL-- 34o- Z 1-
Fill in fee simple Title Holder on next page(if different E-Mail: Iq 40EG rn,ii I• C6 m
from the Owner listed above) State or County License: E GI 300 9-St
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'StIOE MENTAL,CONSTRUCTI ,.,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: of 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 wor or recordirm your Notice of Commencement.
&J -� ���174 � -
s
SWnature OwnLessee/Contractor as Agent for Owner Signatur f C tractor/License Holder
STATE OF FLO IDA STATE OF FLORIDA Q I
COUNTY OF G%/ � � COUNTY OF _UGIT
The f strume t cknowledge fore me The for ojng instrum t was acknowledged before me
this day of 20 by this day of e—Z 20/�by
i
(Name a erson acknowledgin ),•;:jive'' , SYLVIALOMBARDOZD ( me of person acknowleffw�
MY COMMISSION ii FF 936 ZrION FF 938294
EXPIRES:February 22,20 bruary 22,2020BondedThNNotaryPubGeUnde ryPubHcUndervrtiters ,
t ignature of Notary Pu • -State of Florida) (Si nature of Notary Public-.State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS