HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date;
Permit Number:
Buildiner Permit Annfir ntinn
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Fierce 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
PROPOSED IMPROVEMENT LOCATION:
Address: lcl j j � c
Legal Description;,
2
Property Tax I D #:
Site Plan Name.
Project Name:
Setbacks Front` Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
9
Lot N o.�
Block No.
CONSTRUCTION INFORMATION:
ilk itior work to 6tepermiz — cnecR aMhutters
apply:
Y:
HVAC � Tank as Piping _ 7 Windows/Doors
Electric UPlumbing Sprinklers 0Generator
Roof Roof pitch
Total Sq. Ft of Construction: S Ft, of First Floor:
Cost of Construction: $ Utilities:LSewer D_ Septic Building Height:
OWN ERAESSEE:_I CONTRACTOR:
Name
i
Address:�� C> `
city.{— State: q_L
Zip Code: Of� 1 Fax:
Phone No_
E -Mail:
Fill in fee simple Title Folder on next page ( if different
from the Owner listed above)
Name: L C_V
Company:W e-VAe.Se �iMcfy�����
s
Address: L �a
City: 1 l,- �_UCA (L State: t_....
Zip Code: S 4-415 ? Fax.' -7-72
Phone No --I -1 - I - 3
E -Mail: '-'A �iS tosM p k rt �+L7 i e� (YICc+
State or County License: Crc 1 i, 29
If value of construction is $2500 or more, a RECQRDED Notice of Eommencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFUKIVIAI IUINI:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: � Not Applicable
Name:
(Name,
Address: Address: State:
I City: State: City: Phone: Phone: Zip:
FEE SIMPLE TITHE HOLDER: Not Applicable rName:
G CI MPANY: Not Applicable
Name: Address: City: Zip: Phone:.__.._ Phone:
1 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, l do hereby agree that 4 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,
accessary 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.
nature of Owner/Lessee/Contr Agent for Owner
STATE OF FLORIDA
COUNTY OF a —
The for oing instru ent was cknowledged before me
this day of 'tel 20 t1by
s
Si k ure o�Contra�ctorjLicense older
ST ATE OF FLORIDA
lC�c+�
COUNTY DF '-1
-
The forgoing inr ent wa acknowledgedbeforerybefore me
this _ --I day ofi 20 1 f by
(Blame of person acknowledgyr�}' (Name of so elcn lewd
J
f</'_ gnature of Not y ublic- ate of Florida }
(Signature of Nota�Y.rublic ate of Florida j
Personally m .`�A�yg�tPYA+OMDPkiZPATi:1C7�
1 Personally Known OR Produced Id f_ication Type of Id rel _ QUU(
Type of i ia IQ�,. tic .p: °; my COrttION FF233�Z
;aka o EXPIRES May 21.2C(yeal}
pVtY GOisYISSlonl ��23.2rs2 Commissi
ealj��a. sem_
y 21
Commis . E 4cn�i+aa:-sa
..r r52-z:'Sa Fior
Revised 07/15/2414
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COUNTER
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INITIALS
ZONING SUPERVISOR PLANS VEGETATION I SELE
REVIEW
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n
MANGROVE
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