HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICA LE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: Jr' 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
I PROPOSED IMPROVEMENT- LOCATION: -- - .-- - .- _ __-. .....-1.1..1
Address:
Legal Description:
3
Property Tax ID #: 3� 7-- ge k d eyy-- d06—G Lot No.
Site Plan Name: d4 Block No.
Project Name: .
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
cjax'4 6.44
CONSTRUCTION INFORMATION:
Additional work to bener orme under this permit —check all appy:
aIHVAC _J Gas Tank 0Gas Piping _ Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers I Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities: D Sewer []Septic
Building Height:
OWNER/LESSEE:
CONTR TOR:-
Name
.
Name:
Address:
Company:
City:
Stateal�_
Address: '
Zip Code: .3A19c5'% Fax97.o-
&/-a 7?81
City: State:.
Phone No. %-�76 lP
d7Q 9Z
Zip Code: 9 ' j Fax:97a?.. V4 _D_ 77�'
E -Mail: r ¢—
12.QC
Phone No. 12 22 - VL/ 7—r
Fill in fee simple Title flolder on next page ( if different
E -Mail;/ n,,¢
from the Owner listed above)
State or County License:_,"e- /34Y —Jr 59
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it value or construction is ozzouu or more, a KtGUKDtD Notice of commencement is required.
..
S.UPP�LEME'NTAL.CONSTRUCT,ION LIEN LAW INFORMATION
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:
1 certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in coniylict with any applicable Home Owners Association rules, bylaws or andpcovenants 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 len�an attorney before
commencing work or record ravour Notice of Commencement
as Agent for O
STATE OF FLORIDA STATE OF FLORIDA j
COUNTY OF -~ rv} ____ COUNTY OF _ 't 4 Q_ti C .....�
The fol instr e t a acknowledged before me The forgoing instrument w s acknowledged before me
this j 9 day of �_ 20 J-4by this �rday of �� 20 by
(Name of person acknowledging) (Name of person acknowledging)
1�) � 'e r,. --
(Signature of Notary Public- State of Florida )
Personally Known _ _V_ OR Produced Identification
Type of Identification Produced nm ii2Sm
_01 NOTARY Pili
Commission No. % uU7 STATE OF F1
Comm# FFIS
Revised 07/15/2014
(Signature of Notary Public- State of Florida )
Personally Known i,,/ OR Produced identification
5ilaf Identification Produced
DAVID RAYMOND
. mission No,�� 2f:,�
NOTARY PUi3LiC "
K _ %S&ATEOFFLORIE
Expires 1/28/2019
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MANGROVE
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DATE
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INITIALS