HomeMy WebLinkAboutBULDING 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: <-- )i C
f
Legal Description: i�LCL. 1 S
( rr,\Cntn X311',). C
Property Tax ID #: � � �_'- S Z5t7 — OC7 1 SC �i Lot No. 1-7
Site Plan Name: - Block No.
Project Name: \:" C),_ (k=4 4Z) Q vJ
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIP`T..,JON OF 1ti0RK
r�
CONSTRUCTION INFORMATION:
m na war to e e orme un er this permit - c ec a app y:
11
IVAC Gas Tank E]Gas Piping _ Shutters ❑ Windows/Doors
El
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction: $ U Utilities:0Sewer 0Septic Building Height:
:
CONTRACTOR:
�C�.vJ
Name:
rAddress:5 aA PES tis Cir_-
Company: C GC
�el+✓s_ State:E2
Address: 0�
Fax:
City:; i i o^¢ , .StatePhone
No. �(� - S `�� - �) to
Zip'C"ode:Lf Fax: 919} -'�
E -Mail:
Phone C151 - -S •`7l lv
Fill in fee simple Title Holder on next page ( if different
E-Maili
State or County Licenser C - USSS 1L
from the Owner listed above)
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City.
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip: Phone:
--•v wil i n. i wn mrriuvi 1; Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.
is inoconflict with any applicable lHothat
e Owners Associations ru es abylaws or anScovenants that build
ay restrict or 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 firstinspe Ion. If you intend to obtain financing, consult with lender or an attorney before
commenclnix w prnrrllna vnl lr Kintirn of f.,w....e.............a iJ ,.
as Agent for Owner
Contractor/License
STATE OF FLO�1pA STATE OF FLOP
COUNTY OF C L COUNTY OF
The forgoing instrument was acknowledged before me
this Q day of,� ^ 20� by
\- r" -Q& .-4. 1% 1 C5Na�
Name of person making statem&t
Personally Known —mac OR Produced Identification
Type of Identification
Produced
'�MC� �itn t
(Signature of Notary Public- State of FlorPda )
Commission No. �_ (Seal)
REVIEWS ICO NTER I ZONING W SUPERVISORREVIEW
Rev. 8/2/17
The forgoing instrument was acknowledged before me
this =_J_ day of Q[Yi�E 20f� by
-V\ t _GG C" C'r�
Name of person making'statehent
Personally Known_ OR Produce Identification
Type of Identification
Produced
(Signature of Notary Publi - Stao of Florida )
Commission No.-9_� (Seal)
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW