HomeMy WebLinkAboutBuilding Permit AfpplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 I f 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 end of line
PROPOSED IMPROVEMENT LOCATION:.
Address: U��' \ M t , i 1 '� r1n f--.
Legal Description:l a
Property Tax ID #:�� '-� - {`>�® { _ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CQrn o•.�,c tu-� - ryes '� o
a'10 r
CONSTRUCTION INFORMATION:
Add itip is I worR tote,r 1" 111 1 n un der t is permit - c ec a app y:
HVAC Gas Tank Gas Piping OGenerator
Shutters Windows/Doors
Electrie plumbing ❑Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ (Os�- �� Utilities:12Sewer 05eptic Building Height:
OWNER LESSEE: CONTRACTOR:
Name— ( `l Name: c_L�
Address: I ', o Company: PLuA�U S I dQ t
City: State: I'll Address: I°& SG— kkCA-\ `L —
Zip Code: l �}j� Fax: City: C (L State: F—L
Phone No. Lrl f-) Zip Code: 346 S P Fax: -7-7.2 -3M- 2-G90
E -Mail: Phone No. - I -1D= - &5_1 j 6 F Z
Fill in fee simple Title Holder on next page { if different E -Mail: eneGiS Jam.6i n, i
from the Owner listed above) State or County License:
va-- � ..%J„otl uc:iivn M ,?/_3uu or more, a KELUKIJU) Notice of Lommencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:.
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: y
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City.
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:_
Zip Phone:
Not Applicable
State:
Not Applicable
1 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 Nome 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 recordin our Notice of Commencement.
Signature of Owner/ see_7Contractor as Agent for Owner ignature of Contractor/ License oli�er
STATE OF FLORIDA4} STATE OF FLORIDA
COUNTY OF ; 'r � � ' i COUNTY OF ;_. e -le,
The forgoing instrunAent was acknowledged before me
this day of 20
(Name of person acknowledging)
(Signature of Notary Public' -State of Florida )
Persona ll Known
y Pr�l�lei��f%�iZ
Type of ldentificati Commission # G(3,9715-0-1
sr .� y ommGssi n x i
%` Apr k 2 4 15 20 21
Commission No. `""r'"'d`
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
The forgoing instrument was acknowledged before me
this day of L 20 by
e�C:%i�i• 1 �rV rte_•
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known PrcffAt 91detANR f
Type of ldentificati°o 1 Commission # GG 971 50
�*
v, a My Commission xpire
'•';f`a'�April 021
Commission Na. "«n„„n�`
SUPERVISOR
REVIEW VEGETATION
S REVIEW LE j MANGROVE