HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' � �• Permit Number:
Building Permit Application p�
Planning and Development Services MAY 16 2017
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
,.PRO,POSED,IMPROVE M.ENT LOCA ON
Address:
Legal Description:
Property Tax ID#: 0422 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK"
Moo& 'Ar J&_a�
E
CONSTRUCTION I INFORMATION: -
Additional work toe nerformed under this permit—check a appy:
W❑ AC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
_Electric ❑Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ [� Utilities: Sewer❑Septic Building Height:
T
OWNER/LESSEE: CONTRACTOR:
Name Name: 'If-tvoeA C , ll np J C
Address- Company: — C
City: .Statee- Address: Q+
Zip Code: Fax: City: S,ta/te:`
Phone No. Zip Code• �Fax:'7 7„2'
E-Mail: Phone No. O�• •5 115
Fill in fee simple Title Holder on next page(if different E-Mail: I w,M909V
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
ignature f Owner/Lessee on ractor as Agent for Owner Signatur 'f Contractor/ ense Holder
STATE OF FLORA t STATE OF FLORID t
COUNTY OF C, J COUNTY-OF
The fogging instr n was acknowledged b fore me The forging instru nt was acknowledged before me
this day of 20y this day of 20 by
&ieah ew,')
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(Nameo pers n acknowledging) (Nam of erson acknowledging)
ign ture of Notary P c-State of Florida) ignature of Notary ublr State of Florida)
Personally Known R Produced(dent icati n Personally Known OR Produced Identification
Type of Identifi Type of(dent'
•:i;1:?; F;,� —L1 RTTA. •ii+�Y?y" LIBERTYA.KING
Commission No f (ytYCOMMISSIO 090638 Commission MY COMMISSION#G(SQ9438
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IRES:May 4,102"
, 021 i;; �o;= EXPIRES:May 4,2021
{���y,".••'•Bonded Thru Notary Pyt>s�c U)tdeiwdters p4((•tsto -gamed Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS