HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' L A ( ri 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) 452-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, ciick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: q �, aA-
Legal Description: Q V 7 :� AT _11Y.1
Property Tax ID #: 7� (D
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Arirfitinn;d wnrk to he nertormed under
EHVAC Li Gas TankO.
Electric M Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ '� ,
Right Side: Left Side:
1— e5
Lot No.d
Block No.
this permit - CnecK ail apply:
Gas Piping Shutters D Window's/Doors
_
Sprinklers Generator FJ Roof = Roof pitch
S. of First Floor:
UtiIitiesInSewer Septic
OWNER/LESSEE:
Name F -
Address:� r
Stat-
City:� �� e e
l �-
Zip Code: (
c Fax:
Phone No. 4�q 0
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Company: ev ezt PL -L tix.3t#NJ cSG t
Address: I°IQ&- SE
City:1s C- State:
C]�
Zip Code: r Fax -.-7'7.2 -33E` 2�i6g()
Phone No. -I -cis 11 U 2
State or County License: CEC lL29 -
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
MORTGAGE COMPANY:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicab
State:
Not Applicable
Name:
Address:
City:
Zip: - Phone.
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone.
Not Applicable
State:
Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County k th no
representation aathHomeat is
gersect structure
tAssgocrat Ong rulest will , or ze and covene ermit ants that build
rethe strict prohibit such
which is in conflict
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration of the granting 6ansrthe Florida Bu lding Codes and Stit, I do hereby e Lucie that
Coulnty Amendmrespects,
entsperformthe work
in accordance with the appy p
The following ctureisg permit
applications ols, fences, walls signs, pt screen rooms and aundergoing a full ccessory uses to another nonncurrency review: room -residential use
accessory structures,
WARNING TO OWNER: Your property.
A Nto otice of Commencementmustmust be recoencement rded and posted paying in your ontheijobsoite
improvements to your property
before the first inspection. ;f you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
see Contractor as Agent for Owner
Signature of owner/
STATE OF FLORIDA
COUNTY OF LUC
The forgoing instrument was acknowledged before me
this 4 day of , 20 )jvY
(Name of person acknowledging)
signature of Notary Pu � Stpte of Florida
Personal~'sion #VGG 97150
Type of Id - P Nay com
, Aprll 24, 20
Commissi 11
Revised 0711.512014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
STATE OF FLORIDA Luc ;,I {,
COUNTY OF
The forgoing instrument was acknowledged before me
this day of l lji-1c, J 20 by
1 ] (lam j s
(Name of person acknowledging)
(Signature of Notary Public -,5t e of Florida )
Personal! Ku Ao 9 i i ion
i k
Type of I A* P
My Commission Expires
y nom', April 24, 2021 Sea;
Commiss
SUPERVISOR PLANS VEGETATION SRT RILE MANGROVE
REVIEW REVIEW REVIEW