HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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RECEIVED
Building Permit Application JUN 2 7 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
Address:
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:,
Setbacks Front_ Back: Right Side- Left Side:
(AltL 4-r4
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dditional work tobe Derl under this perm tt—check all apply.
YHVAC I I Gas Tank 0Gas Piping Shutters OWindows/Doors
FlElectric ri Plumbing OSprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction-, SQ. Ft. of First Floor:
.12
Cost of Construction-$3300 Utilities:Flewer I ]Septic Building Height:
Name.DAvio W . plice- Name:1. 01+,&.5 tm De
Address:4444 W NAA Api- 9 a Company:G-09ec-Co Lk
City- &�k�rc_e_ State: Address: 5Z tLerr-o 0 fru e, -
Zip Code: Fax. C ity.-pod5--4- 't State: .
Phone No. 27 _ 332 - 575f Zip Code:aqll' FaA -33!r-LJ9J,.1?
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E-mail: 1 11 Phone No. 7 /a- GIct -1113
Fill in fee simple Title Holder on next page(if different E-Mail:S u Vereao ,r j; A'oq MrSN C.0-m—
from the Owner listed above) State or County License: C -X
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If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
DESIGNER ENGINEER: Not Applicable
M
O
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AGE 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
commencin work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA4 Ld STATE OF FLORIDA A4
COUNTY OF kkt COUNTY OF lok/�'N
The forging instruq*' t was acknowledged before me The forgawg instrument was acknowledged before me
this Z?icday of r,,)glue., zo 1*7 by this 27 'day of jvVe- ,20 1 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[den3ification Personally Known OR Produced Identification
Type of identification Produced Type of Identification Produced
U501t (Seal) (Seal)
Commission No. Commission No.
at awtho
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116ised 07115/2014 Nor**N*ixi50"WMW &Pho WV&
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEWREVIEW REVIEW REVIEW
DATE
-COMPLETE
INITIALS