HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ( l n^l )
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Building Permit Application JUN 15 20f7
Planning and Development Services PEWJiiN71NG
Building and Code Regulation Division St. Lucie ounty, FL
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
5 i
PROPOSED IMPROVEMENT LOCATION °.
Address: f' L f YL4 f CC d" C(V L
Legal Description: c Lc%
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Property Tax ID#: //
cd-,J' Lot No.�_
Site Plan Name: 4(/Lt?- Lra Ie` Fri f r c,(L Lam/ J Block No.1�
Project Name:
Setbacks Front Back: Right Side:' Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION LN FORMATION
Additional work toe nerformed under tispermit—check all that appy:
0HVAC 0 Gas Tank ❑Gas PipingOGenerator
Shutters a Windows/Doors
Electric Plumbing Sprinklers Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ d QQ Utilities.. _Sewer E]Septic Building Height:
OWNER
/LESSEE I :CONTRACTOR
Name Ma,d (C.d- KavA-u4 �th, 4 Name: rQ:.. `ice C
Address: / C C Company: r C
City: c State: L Address: M
Zip Code: ax:_ City: Statu�e``
Phone No. 7 Zip Code:L3 'ff 6,>— - Fax: 7 7 7i66�fS
E-Mail: Phone No. 7 7I'—C{(.1
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or Coun License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 a5applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult thyour 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 witIf 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 roomVnd accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Noticeof 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 flnanc)ng,consult with lender or an attorney before
commencing work or recording our Notice of'Comm ericeme t.
Signature of Owner/Agent/Lessee Slinature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ` q
COUNTY OF 4 LICE) COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me.
this 4 tday of - -201-t-iry this .day of 20�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification ^�
Type of Identification Produced R f . Type of Identification Produced t_•
Commission No. e I Commission No.Fri It
, o,6 • A . NIELSEN
t 3
7CommGt ,
Commission Expires �;°�„°:`` - June 12, 2018
Revised 07/15/2014 Juno 1 2, 2 01 a
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIAIS