HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �`�y- 17 RECE1%'_0 AUG 14 2017 Permit Number: �1 �
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 t!
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROMOSED IMPRQVEMEN t LOCATi.O ' _ , q ' }
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Address: /VW Lf Cf pa �-9
Legal Description: 1 t 0KJ:) rA,/ /� [�FiP ha:L �(J rJ i �0-;a(a
Property Tax ID#: �(y3 6 (,:-0/- D o xo- 0 D 0- Cf Lot No.
Site Plan Name: / Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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TAILED'C�ESGRIPTINF WORK , r y vyh r;F t "
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COISTRUCTIO INFORMATION �` ' v
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Additional work toe e orme under this permit-check a appy:
HVAC 13Gas7ank ❑Gas Piping _Shutters Q Windows/Doors
Electric ❑Plumbing U Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Constructibh: S . Ft.of First Floor:
Cost of Construction:$ V_50.- Py Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR "rT
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Name lzn Name: 0r.i
Address: ! 3S010 WXWCi�Ge f/uw� Company: �+ 1-4,CP 6 orcg "o <S
City: ��( r -r State: Address:111 7 S i,✓ H� 1 I; k i �4f
Zip Code:—?V 1 4?Q Fax: City: A�-f' S4_ (amu ti e Stater
Phone No. 67 03) Y- �.�1 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: ,-00.5?
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SLIP��PLEMENTA CONSTR 1CTiPNtU I LAW INEORMATI(JN � �
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GNER/ENGINEER: _Not Applicable RTGAGE COMPANY: Not Applicable
Name: Nam
Address: Address:
City: State: City: State:
Zip: Pho Zip:
� ne:
7.
FEE SIMPLE TITLE HOLD : 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
commencin work or recording our Notice of Commencement.
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Signatufe of Owner/Lessee/Contractor as Agent for Owner Signatur of Contractor License Holder
STATE OF FLORIDA STATE OF FLO�IDA
COUNTY OF Sk I.-%)c�� -COUNTY OF k , L ui%-q,'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-J!f�day of 9� 20Iby this l%1 day of 20 -Q--by
a Yl� t-
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Prodpced Identification
Type of Identification Produced 14D L Type of Identification Produced V\ de
Commission No. 0. 4&4-Ae,1 (Seal) Commission No.:DEQ (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS