HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
A111772— MIT3.9� Rf 77=
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: I o' l e V e
Legal Description: `�`l'�Y•t i�(d' �t
Property Tax I D #:
Site plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
Lot No.
Block No.._�
I DETAILED DESCRIPTION OF WORK: I
C�D crv-, ` n
14v Q11,
CONSTRUCTION INFORMATION:
e %� rPr- i C` t C1 f L C C t;it
icimonai worx to oe errormea unser tnrs permit — cr
E1HVAC Gas Tank [:]Gas Piping
11 Electric L J Plumbing Sprinklers
Total SA_ ft of Construction:
Cost of Construction: $
Shutters ❑ Windows/Doors
Generator Roof
SFt. of First Floor:
Utilities:Sewer Dseptic Building Height:
OWNER/LESSEE: I CONTRACTOR:
Name
Address:��"\;`i�e
City: C -i L e_i_C * State: A�L
Zip Code: �"` qS Fax: j
Phone No. i LA �� — C)q( 14 �T
E --Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Roof pitch
Name:
Company:e_^e_S't L_( �.Sl +g t`
Address: 9 ` O'�
City: 't. State: 7a:L
Zip Code: &6 Fax. -7-7.2 -3BS- 2-6$0
Phone No. -1 _IDL - 35-1- %$ 2—
E -Mail:
E -Mail: C�eAeSjS,��LAt n c 5evt?i e�t�g.r°1f?^��ci
State or County License: C__EC,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW lNFUKIVIAI IUIv:
DE IGNERJENGINEER: Not"Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
! ZONING
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 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: `dour 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,
s
attsre of �Ovtner/�Lessee/�Contr�'.gent for Owner Sig, ure of Contractor/License Holder —
S T ATE OF FLORIDA � STATE ATE CIF FLORIDA
COUNTY OF jt- t > COUNTY OF cs-- t -L L.Lc�t C' -
The forgoing instru ent was acknowledged before me
this -�T day of 20 t1by
(Name of)person acknowledgirC ),
c�
(Signature of Notary ;R6bliclState of Florida j
Personally Known _, OR PrGdl
Type ofP� rt i agaTJif ?rq
Commis tvlY C{ili�itliSS#�[v $ X23 ia8
1401) 360-F1' S3
Revised 07/15/ 2014
The forgoing instr ent wa acknowledged before me
thisda y of 7!'` -I 20 � 7 by
i
(Name of oPfsorAckn
ature of iVotafysublicstate of Florida j
Personally e r tion
Type of IdgnRrn Pi`$`tl°li"�rz�vuoaaoirxa�, ra�c;c t
DIY
Cornmissl jn 29, 2C(Tea1)1
311a -z;,
REVIEWS
FRONT
! ZONING
SUPERVISOR
PLANS
VEGETATION
� SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEiN
REVIEW
REVIEW
REVIEW
DATE
I
COMPLETE
p
INITIALS