HomeMy WebLinkAboutBuilding Permit Application F i i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f1
Date: l Permit Number: I. ( 1 CJJ • 0301
IJ
7-
`` : Building Permit Applicatidn
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 LX
PERMIT APPLICATION FOR To Select from dropbox, click arrow at the end of line
FRPOSED IIJIPROVEMENT LQCATIN
Address:
Legal Description: ( iCQ �� dl � ®fJ /
7� I t G
Property Tax ID#: Y/� �GCK Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
:-DIET ILED DESCRIPTION :OF WORK
i
A f7
g
-..
CONSTRUCTION INfORMAT[ N• �; t _
rtione work tobeperformed un ert ispermit—c eCK ail tat appy:
1]H1/AC GasTank ❑Gas Piping _Shutters in s/Doors
Electric 0 Plumbin Sprinklers E Generator E_Z,of
700 Total Sq.Ft of Construction: 5 .Ft.of First Floor:
Cost of Construction:$ r Utilities: _Sewer Septic Building Height: C/Ak j7a�cl
t
01NN ER/LESSEE
CONTRACTOR
Name
Name: 7 C1I
Address: Company: c� ((
City: e e- S State: Address: (�
Zip Code: Fax: City;
� � State:
Phone No. 7 0(t' Zip Code• `/-1 !', Fax:
E-Mail: Phone No,
Fill in fee simple itle Holder on next page(if different E-Mail: .CI e, C44-10 C
from the Owner listed,above). State or County License:
I,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
11
SUPPLEMENTAL CONSTRUC'fIQN UEN LAW INFQ�MATIO'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: i Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:i
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 in,
'
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 recordina vow Notice of Commencement.
s
Sig
nature of ntractor/License Holder
gnat�ur�ef Owner/Lessee/Agent
STATE OF lF1.ORiDA /J/ 14 . STATE OF FLORIDA �t
COUNTY OF / r f IY t 4 _ COUNTY OF ,/ mld:r - J
The forgoing instrument was cknowledged before me The forgoing instrument was ack wedged before me
this f ay of 20l by this It ay of��20 by
(Name of e n acknowled ing) (Name of OpUm acknowle
dging)
(Signature of otary lici Stat of Florida} (Signature of otaryZ!%:Rproduced
o f Florida}
Personally Known - OR Produced Identification Personally Known identification
Type of Identification Produced Type of Identification:Produced
Commission No. 1'J~�' Commission N .�►.�..i..e►. 5e i)
—�ROYDIFRAMPTON ROX D FRAMPTON
Nota Public-State of Florida - e aFlorida
Commission#FF188186 Commission#FF188186
Revised 07/15 @Wommission Expires Jan.8,2019 My Commission Ex Jan.8,2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION i SEA TURTLE MA GROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
HATE
COMPLETE
INITIALS