HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��
Date: /� Permit Number:,'�I
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Buil-cling Permit Apptication i
Planning and Development Services II
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ill
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Res'i'dential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the,end of line
-PROPOSED IMPROVEMENT- LOCATION--
Address:
OCATION:Address: Q qlj 1 1A-
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Legal Description: �7/ 39 r
Property Tax ID#: 132 7- S01' 00'Y7 000 - 7 Lot No.
Site Plan Name: '' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: !'lll
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy: j 11
HVAC 17 Gas Tank Gas Piping _Shutters i, Windows Doors
Electric E] Plumbing Sprinklers Generator i� Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: l I Irl,
Cost of Construction:$ o�Jr�• 00 Utilities: _Sewer Septic iII,I Building Height:
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OWNER/LESSEE: CONTRACTOR:
Name- Name:
Address:
Company:
City: „coi± State:, Address:
Zip Code:34/96/ Fax: City: ill State:
Phone No. -71a - 332• _3.k4W Zip Code: .31f9#s ili Fax:177��
E-Mail: Phone No. `772- 46 -277 7
fill-in fee simple Title Holder..on-next-page(if different ...E-Maga;/� 1,ze'&_ PA,1 d e - ej"g-h i CCU - Com
from the Owner listed above) State or County License"186 /3 00-.58S 9
SL ,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required:`1
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SUPPLEMENTAL CONSTRUCTION LIEN LAW .INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: XNot Applicable
Name: Name:
Address: Address: 'I
City: State: City: State:
gip: Phone gip: -Pione:iit
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address: "I
City: City:
Zip: Phone: Zip: Phone:!!'I
OWNER/-CONTRACTOR AFFtDVUT-:-Application is hereby made to obtain a permit to do tfie work and-instaiiation as indicated:
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 hold�l r to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants'1that 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„a��other-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 ou intend to obtain financing, consult with lender''” r ttorney before
commen re96rdinJz your Notice of Commencement.,------__ ;,;i
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Sig t re of Owner/Le a Contractor as Agent for Owner Sin ure of Contracto erase Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF S+ "y rc
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this to day of(�4y 69—&- 120 1-7 by this G day ofOc4c 6e-' 201'1 by
Name-of-person--making statement -Name-nfperson making-statement
Personally Known w"' OR Produced Identification Personally Known &i OR Produced Identification
Type of Identification Type of Identification it
Produced Produced l
(Signature of Notary Public-State of Flo6"A.pm (Signature f o
„�„�,,,,, !i'II ANGELA M
CommissionTVo. Vr� SDA Comrnissio ;PaYPU`�= ,Notary Public Stat�.pfFLQnda
* ”! am ssion#FF 0 ,
Colne 13/2019 °oe My Comm.Expires May 27,2016
111 4F Of " Panded throe h National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION'I SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW !I REVIEW REVIEW
DATE
RECEIVED i
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FDCIA TE
MPLETED
Rev.8/2/17
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