HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL 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, 1 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.
/neriLessee/Contractor
s
Signature of as Agent for Owner Signature of CC°nacr/License Holder
STATE OF FLORIDAL� U"COUNTY OF �f
The forgoing instru ent was acknowledged before me
this day of ,` 20 11by
(Name o rson acknowledgin
(Signature of No6a,ublic- State o4lorida }
Personally Known OR Produced Identification
Type of Identification Produced
P
STATE OF FLORIDA " l,
COUNTY OF = !U
The forgoing instrument was acknowledged before me
this day of -QI—)ZA 1 .20 1 7 by
(Name of per on a,yknowlPdging )
i
nature of Notary P bl' - State of Florida }
v
Personally Known OR Produced Identification _
Type of Identification Produced
Commission No. ,; i N:":.. j Y^.,. 44'
'- H(IIAYb'ONOFITZPATkiGK Commission No. L:,Y'► //CC,,,.,,''{{
,��- hAT�Hf�giAYMOND CIiTPAT4tIf,K 1
- M COMMISSION # FF233682 Y COMMISSION # FF233682
7 EAPIRES-May�I'D �, a 2S I A a y 2i. 2v y
Revised 07/15/2014 '{°h34C-x'51 FlarAMota,ySaryi m .40h AC -G'53 FlorKWNwaySwA",CCR
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
F L _0 R1 D A'. '
Permit Number:
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 V/
PERM IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: -7073 �i Y)An C�
iQ.
Legal Description: �� �e�iX�4 ( ►1
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Gee b QQ_G_U"e"
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit— check all that apply:
HVAC 0 Gas Tank ❑Gas Piping Shutters Windows Doors
U Electric S Plumbing Sprinklers Generator Roof I
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: U Sewer E]Septic Building Height:
Roof pitch
OWNER/LESSEE: I CONTRACTOR:
Name t Name: S4'i�JQ1t1
�`1SfiiJG 4�C� ��
Address: 9'? c&\Cr,Q_S-p` Company: �i2a? f I G
City:) �dH Q�--�- State:
Address: irk 0, 9 Niv TbOOI AV...e
Zip Code: 01 -79 -(Fax: P-5 L
? City: j' State:
Phone No. 5 % ccs -.2q9 '��% � Zip Code: ) y j Fax:
E -Mail: Phone No. '7%.-- 0ol0
Fill in fee simple Title Holder on next page (if different E -Mail: )1A Q V UA (�1 C (U 1 \4 CI O . C ot, �
from the Owner listed above) State or County License: CFC I Lf � `i vy t
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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