HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED /�D�—
Date: .3- 9- 17 Permit Number:
0
Building.Permit Application
Planning and DevelopmentSeniices MAR ®9 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 r
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 fMPROVEMENT LOCATION. -
Address: V1 I 4q c2 C C1 1 if vcze, 3 `�FS �
Legal Description: 4Yh
Property Tax JD#: Q S'QO rf f o -gorO-"7 Lot No.
Site Plan Name: Block No.
:Project Name: c C'
Setbacks Front Back: Right.Side:- Left Side:
DETAILED DESCRIPTION;OF WORK.
CONSTRCT
UION INFORMATION
Additionalw0rJK to e P eJ orme 'under this permit-check a ` appy:
i
HVAC V _Shutters Q Windows/Doors
_Gas Tank ❑Gas Piping
Electric Plumbing 0Sprin6ers FIGenerator a Roof
y
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ o�T O,�v7,- w _ Utilities
Septic Building Height:
`L
OWNER/LESSEE ; CONTRACTOR:..'
Name &I Name: 6.
Address: (/ Company: !
State- Address-
Zip Code: Fax: /l/�ff City: Ff State:
FC-
Phone No.� Zip Code:3 �t���� - Fax:
E-Mail: 44/4- Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: �d f
from the Owner listed above) State or Coun 'cense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:T City: State:
Zip: Phone: Zip: Phone-
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name• Name:
Address: r Address: T
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 witifthe 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 roomvand accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your-gaying twice for
improvements to your prgperty.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.If you intend to obtain finandng,pnpft with lender or an attorney before
commenanp,work or recording our Notice of Commence en
t6nature of Owner/Agent/ ee _it'6= Signature of Contractor License H er-
STATE OF FLORIDA =Z`°a
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COUNTY OF STATE OF FLORID Y
COUNTY OFo A _
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The fo oing instrument was acknowledged befo e� The fo ung instrument was acknowledged before =Z 2
this 7 day of Rate :#-= ,-20-Tby this day of���20_" by m
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(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Nt6ry Public-State of Florida I irsignaturiVY' otaryPublic State of Florida')
k- ersonaily�K�no ORProduced identification ersonally Known OR Produced Identfiption
t cation Produced n cation Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS