HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
date:.
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue; Fort Pierce FL 34952
Phone: (772) 462-1553 Fax: 5772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATIONS `
Address: ' � � � ; !, X MI P S L
Legal Description:
Property Tax ID #: , J`r TI 36 _I�o 1-(2007-o()Q Lot No. 7
Site Plan Name: �i'1K&CJK P ll)Ci� Block No.
_
Project Name: r B0`JI-q1--_.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
i)EtU, ADD UPJbEl;C4,8)A T Z_1G147'il1,liGt
CONSTRU..CTIO'N INFORMATION
-
Additil work to be nejrtormed under
®HVAC
this permit- check all that apply:
1:1shutters
L_I Gas Tank
0Gas Piping
O Windows/Doors
Electric Plumbing
OSprinkiers
0 Generator � Roof
Total Sq. Ft of Construction:
S Ft. of First Floor:
oer
Cost of Construction:
utilities: 0Sewer
t ] Septic Building Height:
OWNER/LESSEE. "
>CONTRACTCflR:
Name �1 ?`11.
Name: &--ri4rir_ bil,)GE.L7N1l
Address:_ 0,7gC S bti ,�}P--FIP 1
L)V� LrPJ9 J3�
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Company: •C'Ct1ZPf1E 61
City: Pp t ----r1 CSTy
Stater
Address: `7l 73 Qj1(0'at�l A�.
Zip Code: S 4 99 0 Fax:
City: P titer Si /-I State: 1�L
Phone No,
Zip Code: 3 155 Fax:
E -Mail:
Phone No. -77-Z- 370 -67 7555
Fill in fee simple "Title Holder an next page ( if different
E -Mail: b C V P,&JI C /t7T` %tI� �
from the Owner listed above)
State or County License: JE�C.COOZ, 0 7 ,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not.Applicable
MORTGAGE COMPANY:
Dame:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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, wails, 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 yllende an attorney before
commenci ;j?vork or reco_ )ng your Notice of Commencement. ,7
Signatu of Owner% ent/ Lessee Signa re of Contr or/License Holder
STATE OF FLORI AJ STATE OF FI, IDA
COUNTY OF"�4A, COUNTY OF
The for Ding instrument was cknowledged before me
this day of 20-=1 by
r�
(Name of n acknowle ing )
rte,
(Signature of Notary Public- State o�L} Y1y�!iio�
Personally Known I"
Type of Identification P
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
FRONT ZONING
COUNTER REVIEW
��nded tbN
The forgoing instrument was Acknowledged before me
this ___t_ day of �20_Lj by
(!Name of rson acknowl ging)
(Signature of Notary Public-Statgk
Personally Known_
Type of Identification Prodi
Commission No.
JPERVISOR PLANS
REVIEW REVIEW
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VEGETATION S5ATt ffr MANGROVE
REVIEW REVIEW REVIEW