HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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 end of line
PROPOSED IMPROVEMENT LOCATION:
Address: -�)q el t�- 3Lu�� � Y -n a u�� us
Legal Description: AVfi,
.7
Property Tax ID #: ': nA\R— 0L�Ci, -060 Lot No.
Site Plan Name: Block No.
TT
Project Name: �� Y
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
Cb l- Q 1U3(0 - 1 -2 - 1 \(-
CONSTRUCTION INFORMATION:
it al workto ee ner orme under this permit - check a apply:
HVAC L_1 Gas Tank E]Gas Piping _ Shutters a Windows/Doors
II-_ Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: y�
Cost of Construction: $ �S i�
SFt. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
,
Name
Name: 4_ --
Address:
Company:
City: State: _
Zip Code: Fax:
Phone No.
Address: 1`q4d (Wo
LA5�ci-L-f
City: o C
Zip Code: 57��Ci
Phone No.
_ Stater j
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: 1 (TI, VYQQV'CA
d) 67k! R► 1-, 00\ iV)
State or County License:
("` %NC �}O �
IT value or construction is :�l51.)U or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION' LIEN ,LAW INFORMATION.-
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 ilure to Record a Notice of Commencement may result in your paying twice for
improvements to your prop rty. A Notice of Commencement must be recorded a d posted on the jobsite
before the first inspection f you intend to obtain financing, consult with I'.n4ie or an attorney before
commencins work or rec rding your Notice of Commencement.
of Own J�eoee/Contractor as Agent for Owner I Signature
nse Holder
STATE OF FLORIDA 'STATE OF FLORID r�
COUNTY OF % �.L Cid COUNTY OF/
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this `? day of C - 20 Eby this day of�� S t 20 � by
0G- 544 1"'e , /
(Nam7 of person acknowled�i (Name of p rson acknowledgin �1
( igh ure of t Pu c ate of Florida) (S} nature of Notar ublic State of Florida )
G
Personally Known e iijifica 'on Personally Known $�
Type of Identific odw it FF 935 Type of Identi a,o TMGF 9354,
ti "y omm
±,gg1���sc� Gom�meSNovembwc �,��,09 a Expires Novembe'n� ,
Commission N ...: l FxP ..IFN^ Commission N „y
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS