HomeMy WebLinkAboutBuilding Permit ApplicationALL 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
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential t/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �cl� 3TJ1lYLLA�OL)� ( 1�.
Legal Description:
Property Tax ID Lot No.
Site Plan Name: Block No.
Project Name
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: III
_ HVAC
t✓Electric
_Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
—Sprinklers
_ Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof = Roof pitch
Utilities: _Sewer Septic Building Height:
OWN RAESSEE:
CONTRACTOR:
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Name I
Name:
_ ' `' "�lV n�
Addr FHY urLic/ C I� •
Company: ft 1L _TJdC.
City: P� c L,Ci � Stale: R-
Zip Code:- / y // ""��Faa�x:
Phone No. %%� uZ T77f9
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Addr ss:\a&1.0 �fLJ1Y?�S is. FF
City: t'CJ�1' ��qqi LLtCI�. State:
Zip Code: J�Mp) Fax:
Phone No. iQol 0,16
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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E -Mail: /44r 29 � V 401- , `001
State or County License:
If value of constmetion 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. Lurie 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 our Notice of Commencement.
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a re on ra _ icense Holder
Signature of Owner/lessee ntrgcl. r as Agent for r
STATE OF FLORIDA//
STATE OF FLORIDA
�
COUNTY OF 4 r� 4 C e
COUNTY OF - 4�tC •'P
The forgor. g instrume,�t/ w�as� acknowledged before me
this— ay ofJ�, 20(2by
The forgoing instrument was acknowledged before me
this dayof /�lL" by
.20
on acknowledging)
(NIP
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(Name of person acknowledging) - ;s +o;.,
ER A=
e_
(SNotary Public - State of Florid
(Signatureo otary Public- State of Florida) i z
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�OR
Peown V. OR Produced Id
tilcr>` ityn
Personally Known
Produced Identifica n3 3Tyfication
Produced
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Type of Identification Produced
I) msCommission
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No. �7FOli�O(�`% (Seal)$T
N O rljR/15/2014
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS