HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
...
Building Permit Application
AUG /4 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
PROPOSED IMPROVEMENT LOCATION:
Address: 3 145 i A v�, a f S . �[(Cr P10 FL 3
Legal Description: `�I 0 r f�
Property Tax ID#: >'C �q— �O " �l! T ( —(3CAO Lot No.
Site Plan Name: Block No. -3-7
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:`
CONSTRUCTION INFORMATION:
Additionalworktobenertormedunder this permit-check all appy:
HVAC Gas Tank E]Gas Piping Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers [:]Generator _DI-0101'f
Total Sq.Ft of Construction: a900 S .Ft.of First Floor:
I�
Cost of Construction:$ `T J 0 • 0o Utilities t Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR;q -
Name Name:
Address: — G hS AL1 Company:
City: State:_ Address//: .
Zip Code: '-�cf q93 Fax: _ City: MVIIA- J 0� State:
Phone No. of"— -s- Zip Code: 3 3(-/1_� Fax:
E-Mail Lff P one N '_)12
Fill in fee simple Title Holder on ne page(if different -Mail: C
from the Owner listed,above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S PP PPLEMENTALCONSTRUCTION LIEN;LAW_-INFORMATION:
DESIGNER/ENGINEER: T 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 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 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
commencing work Qvrecppding Your N tice of Commencement.
11 s
_Signatur f Owner/Lessee/Agent Signature of Contra or/License Holder
STATE OF FLORIDA 0 STATE OF FLORIDA
COUNTY OF !/ 4—� �>� COUNTY OF ,► ( 7"I�[
The f9rrg�oi g instrumer was acknowled a before me The forgoi g instrument was acknowledged before me
this-l� ay of 20� by this �l ay of� 20 47 by
(Nameacknowledg' g) (Name of pers cknowledgi
of r g)
�(_
�� 0-/--
(Signa re of otary P -St' a of Florida) X(Signatureof otar��OORR
to of Florida)
Personally Known OR Produced Identification Personally K own Produced Identification
ntification Produced Type of Identification Produced
1C__...
ommission No. ea Commission No. ice`" ea
ROY D F MP ON � `-- ROY DFRAMPTON
Notary Public-State of Florida Notary Public-State of Florida
mission#FF188186 Commission
Revised 07/15/ W
7/1S/ 'Commission Expires Jan.8,2019 My Commission Expires Jan.8,2819
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
=INITIALS