HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED )�yT�
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Building Permit Application MAY 1 2017
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
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PROPOSED IMPROVEMENT LOCATION
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Address: �� '@ 12,
Legal Description:
Property Tax ID#: :�3Vo()- Lot No. �
Site Plan Name: Block Noog
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Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK
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n �110 � �1CC + t—iL
CONSTRUCTION
Acid itio nal work to be nerformed un er t is permit—c ec a appy:
11HV_AC Gas Tank ]Gas Piping _Shutters Windows/Doors
_ ❑Plumbing nS rinklers ❑_Generator ❑_Roof Roof pitchEl
oectric
Total Sq.Ft of Construction: pry S Ft.of First Floor:
Cost of Construction:$ 09 o0. y� Utilities:cnSewer OSeptic Building Height:
OWNER RN
Name Name: 1
Addre s: O 9 Company: e(
City: State. Addr ss• 1211 iJ
Zip Code: Fax: City: State:
Phone No. L.--jai4 - 7614, Zip Code: Fax: 7d 441,
E-Mail: Phone No S
Fill in fee simple Title Holder on next page(if different E-Mail: 00z>
from the Owner listed above) State or County License. C oa
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
May 1517,07:30a Fitzpatrick Plumbing Inc. 7724645142 p.2
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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 priorto the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict 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 reviiew'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 Wce;for._,.
improvements to your property.A Notice of Commencement must be recorded and posted on the-jobs be
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.
s
ignatur f Owner/i=JCon ctor as Agent for Owner 'gnatur Contractor/Lice a Holder
STATE OF FLORID�AA ,, STATE OF FLORUWJ
COUNTY OF Z3'i . AA COUNTYOF
The�fQr�gy(►g instru t was acknowledged before me The forgoing Inst r ment was acknowledged before me
this day of t 20 aby this l_day of 20 acknowledged
(N (Name of erson a knowledging)
••••.a�": LIBERTYA.KING
. PAY COMMISSION#GG 090638
;Y? EXPIRES:May 4,2021
(Signature of Notary P tic State of Florida j
Personally Known OR Produced Identificatio a<6en
7Knon, OR Produced Identification
Type of Identificatio Produced Tyon Produced
Commission No. (Seal) Commission No. LIBERTYA IONG
COhWISSION#EE 877248
= EXPIRES:May 4,2017
4t`r snow nit N=1 Nbra mumaers
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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