HomeMy WebLinkAboutbuilding Permit ApplicationDESIG R ENGINEER: X Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: Name:
Address: Address:
City: State: City: State: _
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X 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 recording your Notice of Commencement.
�.D W, 4, , '
_ Signature of Owner/ Lessee/Agent
STATE OF FLOR�gA_ , ,LV'LI , ,k
COUNTY OF �W,`
Thegoing inst I�e,,n w s cknowledge efore me
this day of N V� i , 20 by
Signature of Contractor/License Holder
STATE OF FLORIDA��� /, h
COUNTY OF
The f going instr` M,entt"was ac nowledged before me
this day of I b `ill i�� 20 Al by
so
(Name person acknowledging
0 - G 'U
(Signature of Notary Public- State of Florida
Personally Known X OR Produced Identification
Type of Ide tenon Produced
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Commissio +, 1'a% ; '_; ;NTrSSION 11 FF90404g
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Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
(Name ofdrson acknowledging )
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(Signature o Notary Public- State of Florida )
Personally Known X OR Produced Identification
Type of Identification Pro
Commission No. 'F M F
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SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
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
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address: i L IC.� >L -C L� ��,it �, v
Description:
Le alS�Q(�L1 �Ll�fiit� �.�>ld �C'iG�iYltliU (,(.4'��. U-inti`g
Legal \J �
Property Tax ID #: C)oo , 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:,
Tvti ���r �rn n 1-�) SCK N n K��
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit - check all Mat u1:1 apply:
HVAC 11 Gas Tank ❑Gas Piping Shutters
❑ Electric 0 Plumbing []Sprinklers ❑ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 2500.00
S Ft. of First Floor:
Utilities: Sewer ❑ Septic
OWNER/LESSEN='.
Name VC -tine -44-1 _9W_k. Y_1_i_
AddresslUl '�Viviet+Dn ku-k_
City: DCKi l -t i It State: Kli
Zip Code: 42,2el Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
QWindows/Doors
L1Roof Roof pitch
Building Height:
CONTRACTOR:
Name: Kim Wilson
Company: Premier Plumbing & Air LLC
Address: 108 NE Dixie Hwy
City: Stuart State: FL
Zip Code: 34994 Fax: 772-692-1094
Phone No. 772-692-2500
E -Mail: preplbgac@gmail.com
State or County License: 25222
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.