HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,�`�✓z� Permit Number:
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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
�PR®�,PO�SED IIVIP:ROVEMEIVT LOC/�TIO�,,N: /� /
Address: r-? 5 C),f
Legal Description:
PropertyTaxlD#: 5 �� -5G3� G6y/- G�G � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DEgSCRIPTION OF VI/umN
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MI
V.
C�0 N STR IJ�C OOLN I:N.F�,O R IVI AT I O N::
Additional work to be nerformed under this permit—check all t=appy:
HVAC Gas Tank ❑Gas Piping _Shutters L]Windows/Doors
4 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
ost of Construction:$ �✓QG'� Utilities:n Sewer O Septic Building Height:
OWNER/LESSEE: CO.NT, R�TO'R;
Name Name: d�-�-
Address: C1e/GG S �� i2� � Company 'L 2�ec
City: Stater Add re ss 51
Zip Code:'l� '�n Fax: City ,mutisr - ocf1'-z: State:
Phone No. Zip Code: Fax:.. ?-��� Sss
E-Mail: Phone No. �>a? G^
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: Cd`c
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
01021NSTIRNIrffiil
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 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 permitapplications 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 firs inspection. If you intend to obtain financing, consult with lender or an attorney before
Comm cin rk or recording your Notice of Commencement,—) zi
s
e _Swure of Cpfractor-Atic-ense Holder
tur of�Wner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDt,,,, STATE OF FLORIDA
COUNTY OF: COUNTY OF 15A N.�sL
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_day of 20 _by this�day of Q 2 n by
(Na of person a dv
ckn )ledging (Name of persortAknowledging)
yv
Notary Public Florida
(!�rrnaturb of Notary Public-State Florida re of N�o�tary Public tate Florida I
Personally Known_OR Produced identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal). Commission No, (Seal)
--------------------
LASHAHNAINGRAM Notary Public
d 07/15/2014
Revise Notary Public-State, State of Florida
43� = 41
Revised 07/15/2014
MY COMM.Expires Dec 20,20 18'.
if Florida
MY COMM.Expires Dec Po gnin5l
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COUNTER _RtV1EW_'k --REVIEW-- 'REVIEW REVIEW REVIEW REVIEW
DATE
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INITIALS