HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 � l> Permit Number:
Building Permit Application
APR 17 r,
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
PuROPOSEDIMPROVE IVIENT LOCATION ,,s
Address: .2- Y,6� G-,r-i oar'.
Legal Description:
Property Tax ID#: ��t; 6-di— Oa Y L — GYM — 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION-OF WORK:
CONSTRUCTION INFORMATION:
AdClitional work'toe e orme under this permit—check a appy:'
HVAC 13 Gas.Tank [:]G,as Piping _Shutters ❑WindowslDoors
LJ Electric 0 Plumbing Sprinklers Generator �Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ / O,�G Cl z' Utilities: -71
Sewer Septic Building Height
0,1NNER/LESSEE:: CONTRACTOR
Name J-4 G`G Gr- J Name: Caw r-7 �-f
Address: _ �' r' Company: 5 L.i /--- ,
City: 1 (�;{rL e. Stater Address: '/ w
Zip Code: Y Fax: City: FT. i4' c State:
Phone No. Zip Code: f y S Fax:
E-Mail: Phone No. CIT— r/`G
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
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 thepermit•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 restrictionsphich may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,peFform 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 vath lender o n attorney before
commencoKwork or recor in ur Notice of Commencement.
' nature of Owner/Lessee/Contractor as Ag ,Signature of Contractor/License Holder ass:*'N•,,
STATE OF FLORIDA __ STATE OF FLORID
COUNTY OF '?�9 COUNTY OF
The forgoing instru t was acknowledge fore me a rn<
The for oing instr ent was acknowledge fft ige g g g! 2 xc,
this day of 20 vo o this day of 20 _by 2 m
2 =1�xi; �V5
i;m s m U,
Wo
Ofi?•VC$�S w O= ,9a2 S. o x
(Name of p rson acknowledging) k cg-T,gg (Name of perso acknowledging) 2°'T
c W T 9 ma �a
o- N-rn19 I ti
—v I- A ^�
(Signature of tary:��
tate of Florida) (Signature of Not Pub/c- tate of Florida)
Personally Known R Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. q (Seal).
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS