HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit 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
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PR;®POSED PRIPROUENfENT
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Address: 3 G t 5%. r
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: IC�r,9 Tio,J IA,AI0 SerVi[c-c ANL G
Setbacks Front Back: Right Side: Left Side:
DETA'ILED�®ESCRIPTI®N OF WORK
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CONSTzRUCTIaO�N INFORMtATION � . .' � � "r .<
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Additional work to' rtormed under this permit—check all appy:
HVAC Gas Tank El.
Gas Piping _Shutters Windows/Doors
lectric 0 Plumbing Sprinklers ElGenerator 0 Roof FI Roof pitch
T7alSq. Ft of Construction:. S . Ft.of First Floor:
Cost of Construction:$ r 70� Utilities.. ewer,O Septic Building Height:
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Name [fJ�tc�n A SSOd A-77 o.nl O�6 Cha I F Name: P,pa-
Address:no -3 ✓r Company:;Lo� TL r�
City: 57, G;t �'✓��r" State: Address: '710 S� ✓'-eA��—L✓�9T� �Lj
Zip Code:T GQom_ Fax: City: ,9;1:r,,.Gr -t State:—ArEv.
Phone No. Zip Code: ct R 3 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: //L-1 301 4!J��
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�StJPPLEMENTA�L CONSTRUC�TY®�'N, LIEN LAUV IN,FOR�11tIATl®,N.
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 recordipS your Notice of Commencement.
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Signature of ner/Lessee on actor as Agent for Owner Signature of Contractor/License old
STATE OF FLORID ` STATE OF FLORIDA ,
COUNTY OFS-4 COUNTY OF �,&
The for oing instr _ erit wwas acknowledge before me The for oing instrument as acknowledge before me
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(Name of person acknowledging) (Nam of person acknowledging)
(Signature of Not Public-State of Florida) (Signature of Notary blic-State of Florida )
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Personal Kyo n OR Produ �fI�ent t'on Personally Known ... �U0!JL'Nwnoj
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Type of I ets3µfXgX d Type of Identifica 4
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS