HomeMy WebLinkAboutBuilding Permit Application I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 9_—�_l
-- - 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
PR OPOSED.,IMPROVEMENT LOCATION ;•' . °1
d ( 5 S �lS I�v
Address: -
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Legal Description: • L1.�C i C. (I G(�� -2 L 90 DL k Z IoM IA+- Uk \Af R Ik1 J'
1 W LI OF 6c p�LAN -L L(n Sb W L_1 S o t=i _R)Property Tax ID#: 3 1 �1 - 501- 11 0X__ M D -01
! Lot No.
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Site Plan Name: hh Block No.
Project Name: 1 `Erkm�+ ��n� �"� bV�S
Setbacks Front Back: Right Side: Left Side:
D'ETAILED.DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION:
Additional worK to be nartormed under this permit--cFeRR a appy:
HVAC Gas Tank ❑Gas Piping ILI_Shutters Q Windows/Doors
OElectric Plumbing Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
cost of Construction:$ Ts(0(5.Do Utilities:0Sewer 0Septic Building Height:
OWNER/LESSEE CONTRACTOR
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Name CG -1- Name: rr ((''
Address: lit' ) T Y Company: FY COrd• Gtr
City: State:ELY Address: 3461 �� 1n�1���r►�Q
State:
Zip Code: I 3 ZJ Fax: City: ISS L- p �
Phone No. Zip`I`5�-1 lP Zip Code: 3� 1 Q Fax:
E-Mail: Phone No.��7 Z) K11 1(-y S
Fill in fee simple Title Holder on next page(if different E-Mail:JA 6lC6 C e.4eegl�W6 01• WM
from the Owner listed above) State or County License:. &1-1 CIO [a
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
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SU PPL,EM,ENTAL CON_STRUCT,ION 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 HOLDER: of 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
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee ontractor as Agent for Owner Signature of Contractor/LicensefHo
STATE OF FLORID '' • STATE OF FLORIDA G
COUNTY OF . l�Ct-� COUNTY OF �'T• UG C( en
The forgolgr�g instrument was acknowledged before me The fo ing instru ent was acknowledged before me
this �Zy of � 20 nby this 'ay of 2'0 i�by
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(Name of person now edging) (Name of person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of N;gtary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced! Identification
Type of Identificati uced Type of ldentlfica on Produced
Commission No.
,�r 1 KAREN D.CHISHOL
o, mission No.
al � p I) KAREN D.CHISHO
MY COMMISSION#FF99 A6 MY COMMISSION#FF9 56
H EXPIRES:MAY 18,20 0 EXPIRES:MAY 18.20
�••'°' , Bonded through 1st State Incnee
Revised 07/15/2014 !
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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