HomeMy WebLinkAboutBuilding Permit Application ALL APP BLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: Permit Number: /'05 OS71?
PS 0
Building Permit Application APR 18 2097
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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENTIOCATI`ON. .
Address: 914
Z
Legal Description:
Property Tax ID#: 0L1Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION, OF WORK- .
r"q c, '% a t, . r
V'V"I
,CONSTRUCTION„-IN FORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC E]Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ � Utilities:cn Sewer F]Septic Building Height:
-OWNER/LESSEE:; CONTRACTOR
NameName:
Addres : Company:
City: State-EL Address:
Zip Code: Fax: City: Stater
Phone No. Zip Code: 2 Fax:
E-Mail: Phone No. 2
Fill in fee simple Title H Ider 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.
SUP, LEMENTALCONSTRUCTION LIEN.IAW INFORMATION " . .:.
e ., ao. - .o_
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 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: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 Qf Commencement.
S.
i nature of OwnerAessee/Conf ractor as Agent for Owner Signature of Contractor/License ffolder
STATE OF FLORIDA Dao Wo ad STATE OF FLORIDA mit
COUNTY OF COUNTY OF (�(
The fo oing instru ent was,ac nowledged before.me The 7fing instru ent was cknowledge before me
this T -day of 20 qby thisday of 20 by
_ V 1Hf)7 �26 \
1onV &J- I' KQ
(Name of person acknowle ging) (Nam of person acknowledging)
0 , a2i J��a C�'L9
(Signature of Notary Public-State of y
rida) (Signature of Notary Public-State o lorida)
Personally Known V OR Produced Identification Personally Known V OR Pro ced Identification
Type of Identification Produced Type of Identification Produced
L.L °.�pN..,8�.� P.LISSA LANTIG A I-7 20�,.....`��
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Commission No. MY COMMISSION#FF mission No. * Sed
s EXPIRES:November ,2017 sr °� E PIRESt November 3,2017
BondedThruBudgetNota Services q �F1oma` BandedThruBudget Notary Services
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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