HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
2-ta-1 1JI-AOM
WANN 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: 1
Legal Description:
Property Tax ID#: I -OD-5 Lot No.
Site Plan Name: =al 1i n l� a J( Block No.
Project Name: C p
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
SCE 1 � S UO�
CONSTRUCTION INFORMATION:
i ona work to be nerformed under this permit-check all apply:
AC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Ll Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ � �JL Utilities:cn Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: � L 1 L
Address: Company:
City: �j ( � Q State:� Address:
ll) T
Zip Code: 'JU -1- 1 'l-11 Fax: City: w State:
Phone No. 95A_"1
( (_AS_ W Zip Code: Fax:
E-Mail: Phone CeC
Fill in fee simple Title Holder on next page( if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
F
PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
GNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
e: Name:
ess: 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,swimmin pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: our failure to Record a Notice of Commencement may resul in your paying twice for
improvements to your roperty. A Notice of Commencement must be record nd posted on the jobsite
before the first inspe ion. If you intend to obtain financing, consult w�lei r or an attorney before
commencin ork recordingour Notice of Commencement.
s
Signature of 0 er/Lessee/Contractor as Agent for Owner Signature Co ractor/License Holder
STATE Or FLORIDA) _ STATE OF FLORIDA) ll'
COUNTY OF �';l � l %� COUNTY OF
The forgoing instr ent,was acknowledged before me The forgoing instr ent as acknowledged before me
this ,day of y�__"�(�. .� 20 ) by this ay of .U,c� 20 D by
U
(Name p son acknowied/grfig j (Name,of p rson acknowledging-)-----_
O-N
( 1 at re of N a brilc-St r l� 20� 0,0 ( 'gnature of No ary blic- t e of Florida ) /
ersonally Known ation Personally Known a OR Pr
{ Type of ldent' ' a ---Type of Identificatiari Pr
Commission No. " : ;i x' (Seal) Commission No. :.; ;ges a
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS