HomeMy WebLinkAboutBuildilng Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
O to
7 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 .V—
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: 3�/aLJ 7dZ- a 17a - Voo- a- Lot No. Y_
Site Plan Name: �> Block No. 4.3
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Adclitional work toe nertormed under this permit —check a apply:
HVAC 0 Gas Tank E]Gas Piping nGenerator
Shutters Windows/Doors
11 Electric 0Plumbing Sprinklers Roof
Total Sq. Ft of Construction:: �� 9y Sq. Ft. of First Floor:
Cost of Construction: $ G Utilities: 0 Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameQ 11 C-t4A�eci if
Name: rL_ fq 1✓ tics.
Address: Zl t-:� as1 %/
Company: lqZ fi'/
Address: 2�� •� i i �4f�J -72-4f
City: f Sfi Gat F.e__ State: PC-
Zip Code:-3-/�z Fax:
Phone No. ?-?Z- 607
City: W,& State
Zip Code: -331//_'5__ Fax:
Phone No. -C1 4/.3 2.19 i
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: ry n 0 2-6, % e, r- -r er7-7
State or Ggvnti Lib mui rfico !ff l?1AE5
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not ApplicableM
ORTGAGE 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 iWection. If you intend to obtain financing, consult with lender or an attorney before
commencingm-6Yc or recordi6gdour Notice of Commencemeni,-7
of
re
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I '� GI'Yl ���C//� COUNTY OF
The for oing instru ent was acknowledged before me
this day of 20 (7by
.. / v
(Name of person ackn
lic- State of Florida
�L OR Produced Identification
Type of
Commission No.
Revised 07/15/2014
The forgoing instru ent %yas acknowledged before me
this ZZ/ day of �i i 20 n by
(Name of person acknowledging,)- _
of N
�onally
ype of Id(,
MY COWdJ§PION #FF077427 Commission No.
EXPIRES December 17, 2017 11
13961ic- State of Florida )
(407) 398-0153
MY C(p��eM SION #FF077427
EXPIRES DIcember 17.2017
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