HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST
7 BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / cP /• 1-/ Permit Number:
RECEIVE®
Building Permit Application
Planning and Development Services JUL 2 4 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
PROPOSED IMPROVEMENT LOCATION r
Address: L 3 _Tl
Legal Description: 3 L( 4 rj oiJf4 'a
2 -((F
Property Tax ID#:13 U -5 I a W-d-GU-I Lot No. 6 SCS^
Site Plan Name: Block No.
Project Name: a?(zK-e-S F-T(r C'Ira-
Setbacks Front Back: Right Side:' Left Side:
DETAILED DESCRIPTION OF WORK
a
CONSTRUCTION INFORMATION _
Additional work toe nertormed under this permit-check all t=appy:
0HVAC Gas Tank []Gas Piping - IA Shutters Q Windows/Doors
Electric 0 Plumbing 0Sprinklers F]Generator Roof
Total Sq.Ft of Construction: U Sq.Ft.of First Floor:
Cost of Construction:$ 1.�6 Q Utilities: _Sewer El Septic Building Height:
OWNER/LESSEE CONTRACTOR V
Name 6 e_orr- L Lqr-F e I Name: CR inl-1-9
Address: a Company: r C (AC k17-
City: F tLf State:_ Address: 4 C 03 E t(--
Zip Code: 3 `G S Fax: Lt City: F Statue �
` /
Phone No. ��5� Zip Coder tom' - Fax: 7 7 a "7460
E-Mail: Phone No.
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.
DESIGNE ENGINEER: _-Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name-
Address: Address:
City: State:T City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: .
City: City:
Zi p: Phone: Trp: 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 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 w 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 herebyAgree that I will,in all respects,perform the work
in accordance witKthe 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,screenioomVnd accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your`vaying 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 finane)ng,consult with lender or an attorney before
co_mme worts or recording our Notice of Comme&erfient
may.
Signature of Owner/Agent/Lessee signature of Contractor/License Holder
STATE OF FLORIDA ° r'`� STATE OF FLORIDA
COUNTY OF m° ' ' j COUNTY OF
o The fo oin in nt was acknowled ed before m
The for Jing i ent was acknowledges'` fo g g =T =
this�day of -1. :�► this day of 2n�by o:
m
C:
(Name of person acknowledging) �. (Name of person acknowledging) = m
tv o M7 t E2
vwZ2
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(Signature of Nota ubiic-State of Florida) (Signature of Notaublic State of Florida
Personally Known / OR Produced Identification Personally Known OR Produced Identificatio N
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014 •
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS