HomeMy WebLinkAboutBuilding Permit Application ;I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s J / o / Permit Number:—n,05-0070
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: Fence
PROPOSED IMPROVEMENT LOCATION:
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Address: C3CLCC r^
Legal Description: d
Property Tax ID#: 13 i'--a- -R D 1 - d 1 ga - Lot No.
Site Plan Name: Block No.
Project Name: -P D liq ce _ Ex ASH rho► 2,/sn 1 Er ny
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:' .
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CONSTRUCTION INFORMATION:
Additional work to rtormed under this permit-check all apply:
❑HVAC Gas Tank Gas Piping Shutters Q Windows/Doors
Electric Plumbing HSprinklers Generator Q Roof Roof pitch
Total Sq. Ft of Construction: Sq.-Ft.of First Floor:
Cost of Construction:$ Utilitiesr leweroSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 7 CAI-e m-PY Name:
Address: 3 f),Cc Cir Company:
City: 2-:1 f)-?/1CQ_ State L Address:
Zip Coder-9 4 C1 T-1 Fax: City: State:
Phone No. S/ 8" 1'A U Zip Code: Fax:
E-Mail: ' c m Phone No.
Fill in fee simple Title Holder 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.
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SUPPLEMENTAL CONSTRUCTION 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:
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 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 of Commencement.
NX/'/""7�) --7 V,*0 A s
Si LF of Owner/Lessee Contra oras Agent for Owner Signature of Contractor/License Holder
E OF FLORID� ' STATE OF FLORIDA
COUNTY OF 'mc _, COUNTY OF
The forgoing instruent was acknowledgedLbefore me The forgoing instrument was acknowledged before me
this day of 20 111by this_day of 20 _by
(Name of I
rson acknowledging) (Name of person acknowledging)
&\4�
at re of Notary Public- to of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification� Personally Known OR Produced Identification
Type of I entification Produced Type of Identification Produced
,rrL Nl9il�-y2,.
Commission No. ea o missi n o. (Seal)
LASH HNAINGRAM
Revised 07/15/2014 °r My Comm.Expires Dec 20,201:3 F
Commission # FF 177249 '
�fP OF FW.10
REVIEWS FRONT ZONING SUPERVISOR �JPLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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