HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN�FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Q6?_CZJQV_7 Permit Number: ' 1/
OWN
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
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Legal Description:
Property Tax ID#: 1 ®�� ` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
{�'C E ,Ey '.i�r.: tim .a9+,, .,"av\ �, x.F jJC",w $ E 1cA x �r
kDETAILED�DESCRIPTIONfO.F WORK 1�f ,>3 ' � 5 t, s T , b ¢5 ;
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-9—&.r Oq a,'td f'e—rU p ] S`OACS
itiona wor to a er orme un er t is permit–check all appy:
❑HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof X02 Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction: $ 0�2, �0 Utilities: Sewer'❑Septic Building Height:
:' �aY4•..• +f R1';Yi p y' '� '°"' �iX \ rCY }44.%3£: 1 3 �Y. �{ �..i #.R'1 Y2t'�L k hX'� �"
".OWNER/LESSEE �; g3t
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Name ✓ G>' G I'j 2 Name:
Address: Q RIq 0 ✓e- Company:
City: State:2- Address:
Zip Code: 3q �l Fax: r7 City: State:
Phone No. ( � 02 —� ( 3 Zip Code: Fax:
E-Mail: LJ4F 1 �11�C��"1 Phone No.
Fill in fee simple Title Holder on ne page(if different E-Mail:
from the Owner listed above) State or C74
License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C®NS�TIiUlON LIEN LAW INFORil1/IA1'I®`N. 1
�A�R %v'!ifi1 Sa F.�. fl.N Stilt -
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
commencing work or Wcordipg your Notice of Commencement.
)X—n4zeE s.
Signature ofwar f/L ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 1 p p STATE OF FLORIDA
COUNTY OF �� Vc �C� COUNTY OF
Th r ping instrum t w s acknowledge efore me The forgoing instrument was acknowledged before me
thiay of 20by this day of 20 by
� 1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Nota Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known 0 Pr e I ' Personally Known OR Produced Identification
�" a of Identification Produced
Type of Identifica on`�rZ iced
Type
f ��1P�Y PV9'�
i ;����t`�-; Notary Public-State of Florida
Commission No. = ' commistREa4 FF 234730 Commission No. (Seal)
';r a . My Comm.Expires May 27.2019
FF`°`' Rnarld through Nation alNotarAssn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS