HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
- J =
•
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
PROPOSED IMPROVEMENT LOCATION:
Address: �� 1( f i L_ _e c�
Legal Description: BAR - T cl �'►
Property Tax ID#: 41S�u�. �� I U 33,5 �U V �,� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
l,vCL /oXW 14C4 ;- w
CONSTRUCTION INFORMATION:
iti workto a er orme under this permit—
HV
ermit—c ec a app y:
HVAC �Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ {✓� Utilities:F Sewer II Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name i )h IN i i1C. P i
L � _)u JN �w i �.e""/� Name: L� � k—A
Address: 1-4 C1 LLJ Company: CoL A
City: _..)c.�S;../ hL�i State:�L Address: _3 A 1 Lam/
Zip Code: � , Pfl Fax: City: ' `S Stater
Phone No. �'� %' II `{ � Zip Code: !1 C1 el 3 Fax: k
E-Mail: Phone No. _911 011a, 1q.5__r
Fill in fee simple Title Holder on next page(if different E-Mail: 1TVuC I C t1 K -L 13 (�G MA I L -CaT
from the Owner listed above) State or County License: L,� (2 C) `-t S 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
coMpie9cing work pk recording our Notice of Commencemen
s
Sig ure O nee essee/Contractor as Agent for Owner Signatu Cont ct icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I—) day of (Y,O , 20 Q-by this_aday of (1`1C�r _ 20 L—a_by
(N a of person acknowledging) (Name of person acknowledging)
gnature of Notary Public-St f Florida) (Signature of Notary Public-Statef Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Producec_ r
� ��" V���-'`�l�U•��.I'u, � ,..,.,RAM
Commission No. (Seal) mmission No. (Seal)
L; ctnin.of Flor' a CJ(T M!! _ Fr 17
,. ,
Dec 20, "�"" Bonded throe i National Notary Assn.
Revised 07/15/2014 FF 177249
',y q ,-� ,omm� $jp° tional Notar,Assn.
REVIEWS FRONT QG" SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS