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 34982 g
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: -S- 1 C
Legal Description: 1V1Cy t 'aLv l - Wl ' �
Property Tax ID #: 9t40 2- - b P 0 �_ - CC - S
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit -check all apply:
HVAC r] G Tank []Gas Piping_ Shutters
Electric _ Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ X00
OWNERAESSEE:
Name 1}(C-6 e
Address: 67( 1
City:��C
Zip Code: ( Fax:
Phone No.373 " C361
E -Mail:
SFt. of First Floor:
Utilities:]Sewer ElSeptic
State: a_
Fill in fee simple `title Holder on next page ( if different
from the Owner listed above)
Lot No. L
Block No. 50
Windows/roars
Roof L Roof pitch
Building Height:
CONTRACTOR:
Name: Z5 -662'P(_4 f,+l+-Z_ L_ L_ f
Company: ev1P +� PL_LL44_L J ^Jc, SG4�t1 `cam
Address: ia(0& �SG— `kCA"\
City: �i-W t &__ i _tk6 e_ State: TL
Zip Code: Su",S q Fax.—I-7.2 -3M- 2_690
Phone No.'l� 3-1 ` 69 2 -
State
State or County License: C. ( l.r ;�l 103
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
111
8 ,
1
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit -check all apply:
HVAC r] G Tank []Gas Piping_ Shutters
Electric _ Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ X00
OWNERAESSEE:
Name 1}(C-6 e
Address: 67( 1
City:��C
Zip Code: ( Fax:
Phone No.373 " C361
E -Mail:
SFt. of First Floor:
Utilities:]Sewer ElSeptic
State: a_
Fill in fee simple `title Holder on next page ( if different
from the Owner listed above)
Lot No. L
Block No. 50
Windows/roars
Roof L Roof pitch
Building Height:
CONTRACTOR:
Name: Z5 -662'P(_4 f,+l+-Z_ L_ L_ f
Company: ev1P +� PL_LL44_L J ^Jc, SG4�t1 `cam
Address: ia(0& �SG— `kCA"\
City: �i-W t &__ i _tk6 e_ State: TL
Zip Code: Su",S q Fax.—I-7.2 -3M- 2_690
Phone No.'l� 3-1 ` 69 2 -
State
State or County License: C. ( l.r ;�l 103
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGIN EER:
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 1 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.
Ignature of OwnerXessee/Con tactor as Agent for Ownernature of Contractor/License H r
STATE OF FLORIDA
COUNTY OF ST LfA
The forgoing instrument was acknowledged before me
this day of 1� t`/ 20 / 7by
(Name ofperson acknowledg;
(Signature of Nota�blic-State of Florida
, .�-)
Personally Known OR Produced Igjication
Produced.
Type of uel;ll+ asloiragkiF'��T�"r�i I
Commis; .: ANY COMMISSION # FF2336821eal,
1=xPaKesifty 21.20
14071 X98-L"S3 flondalloia�'Sc�e-�'„ _ 5
Revised 07/15/2014
REVIEWS FRONT
COUNTER
DATE
COMPLETE
INITIALS
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this —5-- day of 4r1_ t , 20 l 7 by
(Name of rs ack wiedgi
gnature of Notary public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced_
�frrzanTa�crc -
Commission No.l�1YGOMS)I^F233682
XpIRES May 21.2019
ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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