HomeMy WebLinkAboutBuilding permit application.PPUCABLE INFO MUST BE COMPLETED FOR APPUCATION'TO BE ACCEPTED
Permit Number:
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
address:
.egal Description:
/'0/00 6�d5 //
Building Permit Application
Commercial
09
Residential
Property Tax ID#: vL�DOE)�S-O0Lot No.__h ✓�
Block No.
Site Plan Name:
Project Name:
Setbacks Front _ Back: _ Right Side: Left Side:
r ff o� /,/A e— L<ecn /yS' f �j«'iSc 7_a /�!c✓
Mechanical — Gas Tank _ Gas Piping
Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Sq. Ft. of First Floor: _
Utilities: Sewer _ Septic
Cost of Construction: $ �i —
Name ltiJ I b 0
Address: 10 '0(,
—
City: Font I0+ it Ce- State:
Zip Code: 344 Fax:
Phone No. 77d
E -Mail:
Fill in fee simple Title Holder on next page (If different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: Cu�tlS S 4i'1 ort S
Company: _Jjn,?A:L Air S�S�e►ns
Address: (le l5 S E TM
l( r
City: Po G-� T C «- G State: t L
Zip Code: X41 Fax:
Phone No. 17" 3 �J L
IE -Mail:
State or County License:
If value of construction is?SWor more, a RECORDED Notice of Commencement is required.
- -A- A
SUPPLEMENIALCONSIRUCIION LIEN LAW INFORMAIION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name: i
Address:
Address:
City: State:
State:
City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
City:
Address:
Zip: Phone:
City:
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
Home Owners Assoaation rules, bylaws or and covenants that may restrict or prohibit such
which is m conflict with any applicable
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
Building Codes and St. Lucie County Amendments.
in accordance with the approved plans, the Florida
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
signs, screen rooms and accessory uses to another non-residential use
accessory structures, swimming pools, fences, walls,
WARN ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice fo r
must be recorded and posted on the jobsite
improvements to your property. A Notice of Commencement
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or rec ding your Notice of Commencement.
5
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Signature of Owner essee/Contractor as Agent for Owner Signature of Contra r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF
COUNTY OF i
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me this day of Ok4L 20 1'_7 by
this day of RPP-« 20 L by
i
SJ ?
m MO r1 S
- �ur1`15 ��in►�toYlS�S -
(Name of person acknowledging)
( Name of person acknowledging)
• � i
(Signature of Notary Public- Stat of Flor
(Signature of Notary Pu/blit- State of FI a } /
' Identification
Personally Known ✓ OR Produced Identification Personally Known OR Produced
Type of Identification Produced
Type of Identification Produced
�4+ pv:
V1 �/ S`i
U1 Ul Q S CHPATIEB mission No. �/
Commission No. mycom is"Sm# 05250 r _•.
' 2021
EXPIMS:
rbnns.ANG `��..'' * WYCOWAsslorlMOMM
Revised 07/15/2014 �o� EIIi M:Apd4,2W
REVIEWS FRONT ZONING 'SUPERVISOR ' PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
DATE
COMPLETE
INITIALS