HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: I I I �- � Permit Number: / 20-7-
Building
2n-7@Building Permit Application
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
PROPOSED- tMiPR.OVEMIENT LOCATIQ,1:
Address: &Ice ff-petl;��_
Legal Description: 4
,Property Tax ID#: / �it��o ��l —Q���� ���QQLJ - Lot No.
,Site Plan Name: a Block No.
Project Name:
Setbacks Front Back: Right Side:" Left Side:
l� bETA[,LEDD,ESCRIPT[,'ONOFWORK:
T (C 0 , �0
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CONSTRUCTION INFORM'ATION':'
Additionatwor to be ertormed un er ispermit—c ec .a ' appy:
[]HVAC Gas Tank ❑Gas Piping - :Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof
cry
Total Sq.Ft of Construction: a d S Ft.of First Floor:.
Cost of Construction:$ l 6 o d Utilities:'n Sewer Septic Building Height:
j OWNERILESSEE: CONTRACTOR ,
Name V-f ztk j2 V- Ka Name: c3t
Address: / `�� p Oct j ��Q q_V'e2_ j
Company: l r rbt-l/-2�
City: 'fi T P(`e _ State:ECS Address: C � c I
Zip Code: t�Fax: City: f l rr- State:
Phone No. Zip Code:3 �'t�'U - Fax: 7 "" �v"_""_`C•C/
E-Mail: N Phone No. 2 7Y—(-f 4.,f—�.3 �a �
Fill in fee simple Title Holder on next page(if different E-Mail: K 0&��C'Qg4ep-2U1( Q l'L.
from the Owner listed above) State or Coun license:
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if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name•
Address: Address:
City: State: City: 1 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:
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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 the permit 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 wdh.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 herebV_agree that I will,in jail respects,perform the work
6 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,screemrooms�and accessory uses to another'non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your_-9aying twice for
improvements to your prgperty.A Notice of Commencement must be recorded and posted on the jobsite
before ffiorst inspection. If you intend to obtain financing;consult lender or an attorney before
comrde'nolhR work or recording our Notice of CommenceMent.-
I
ign ure of owner/Ag Lessee S' ature of Contractor/License Holder
STATE OF FLORIDA STATE-OF FLORIDA
COUNTY OF COUNTY OF
The fo oing i me t was acknowledged,before me The fo oing instrument was acknowledged before me
this 3 day of -20 ff by this day of 20 by
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(Name of person acknowledging) (Name of person acknowledging)
(Si ure of Notary Public State of rida) (Signature of NotaryPublic-S e of Florida)
Personally Known OR Produced Identification Personally Knownlir duceI identification
!Type of Identification Produced Type of Identification P dv,, I GRAD
2
Notary ubl'
mission No. ; " *•`-I
my Co State of Florida
Commission NO. �;, (Seal) �, fres t7ec 20,2018
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Revised 07/15/2014 Bonocd Iniouyh Na;,U�21 Notary ASSO,
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATIONSEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS - �
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