HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j y
Date: Permit Number:
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 ehd of line
.PROPOSED IMPR..OVEMENT LOCATION:
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Address: 1 f U �� t� FL/
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
:DETAILED DESCRIPTION OF..WORK
CONSTRUCTI,O.N]N FO.RMATI0 N..
Additional work to be performed under t ispermit-check all that appy:
®HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑Plumbing Sprinklers 11 Generator ❑Roof, Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 3 6 00^ " Utilities: Sewer Septic j Building Height:
OWNER/LESSEE: CONTRACTOR ;
Name C 5,4 Mk-)L7 Name: O �1l e4-p
Address:7le z 9. 52-C Company: J nom' , C'
City: lr cf a>f C State: Address:
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Zip Code: Fax: City: I� i + Stater
Phone No. Z 33 2-- 33(DS Zip Code: 53 ( 3Y— Fax:
E-Mail: -Phone No. 2K4 • .c�I )
Fill in fee simple Title Holder on next page(if different E-Mail B ve — Al-4-' l�e_41.00 •C,&,-1
from the Owner listed'above)_'' `: State or County License: I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. I
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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 BOLDER: _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,performi'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,
I 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 or recording our Notice of Commencem
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Signat e o wner/Lessee/Contractor as Agent for Owner Signatur of`tcrntractor7License Holder
STATE OF FLORIDA _ STATE OF FLORIDA
COUNTY OF U- 'c`�� COUNTY OFf'..
lThe forgoing instrument s acknowledged efore me
The f rgoing instrumen was acknowledg d before me ��II''
this day of J 20� y this day of ` 20 Y
(#11 -1 P-i C)Q2c u A—_A
{Name of person acknowledging} (Narn\tVf person acknowledging)
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pp,Z 914,1AA FF9
{Signatur ic- I ,� {Si of y at �ftP Lida i
Personale = FR entification Pe oia �wnu1 60
c d,ldentification
Type of Id ' 1Prod �— Typ irtio uced ��—
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40T 'AR 40
Corrrmissio o. {Seal} Com ton No. (Seal)',
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE. _
COMPLETE
INITIALS
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