HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAPLE INFP MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��
�
Permit Number
_ _ J _
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 R;eSidential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at th;e lend of line
PROPOSED IMPROVEMENTrLOCATlO`i\!
Address: ���� �� ��Z �' E3aC� �C�r �rC"f* _2'-lN<�.
Legal Description: Mme C\±2� S) D 05 310 �+D , 5,
YJ K)0 moi- NL") C MP(P -6q/051N) CCQA 3T9(P-1(;(Zu)
Property Tax ID#: 5, 1D rA 0`-6(,p 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF WORK I f'' h
�
�2(�1 C�CC' �Or®fin C C,� 2,., C� r; �1,0.0 C�ncre.-Ee e� a-�
t'ror1-�- Crrkrta n C e.
C�A
CONSTRU CTIQN (NFORM;9TIOIV Adclh
i
itiona wor to e e orme under this permit—check a11 app y:
0HVAC Gas Tank [—]GasPiping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator L�J Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ �� �bC�,� Utilities: Sewer Septic Building Height:
ti
OWNER%LESSEE ; ;CONTRACTOR r a,
�
Name Name: C6�)r 1
Address: "- l 3`%7 15ek V k±z Rd Company:
T
City: �A 9\-C(-C� State: Address:
Zip Code:_E�t�59 k Fax: _1 z- 59000- City: State:
Phone No. `-1 �- 3 t� y t`k 0 Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder.on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.;'
� I
I
!
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:{.:
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 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 recordedland posted on the jobsite
before the first inspection:If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
ignature of Own /Lessee/Contractor as Agent f wner Signature of Contractor/License Holder
STATE OF FLORIDA \ l— STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instrume t was acl nowledged efore me The forgoing instrument was acknowledged before me
thisay of 20 L' by this day of ZO by
ck--
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notari Public-State of Florida) (Signature of Notary Public-State of Florida)
r .
Personal) Known . """
Personally � ��QBQ Prod e N ���� I Personally Known OR Produced Identification
Type of Identification Not y Type of Identification Produced
_ t "
Commission No. '-"9, ";o� ' My CommI Expires May 27Y2019 (Seal)
onded thrd honal Notar Assn.;� Commission No.
I
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
I