HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I��- 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
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Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED. IMPROVEMENT LOCATION:
Address:
Legal Description: o t ) ncl ,moi 1t 1
PropertyTax ID#:] j -� 'I = -_< ot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
l o' 1 3
CONSTRUCTION INFORMATION:
itiona workto e -performeun er t is permit ---c ec
a ' app Y:
i0HVAC Gas Tank Gas Pi in
p g
®Electric
_ Shutters Windows/Doors
M Plumbing Sprinklers
Il Generator Roof Root pitch
Total Sq. Ft of Construction:
S. Ft. of First Floor:
Cost of Construction: $ �� Utilities:liSewer OSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name "rtes f1,'\ -`st
Name:
Address: 5' f�f�11` l~,
Company:— �j.3
City: - ,' State- L
Address: I S2t> rD 2-:: 1!
Zip Code: �� � � Fax:
�
Gty _ ` l_ t State:-F—L
Phone No. i\p) 39 ,t'Zip
Code: (?S; Fax: c'1f1
E -Mail: L 0- C�'rro
Phone No. ns, -
Fill in fee simple Title Holder on next page ( if different
E -Mail:;
from the Owner listed above)
State or County License: CSCCIc� , b
If value of construction is $2504 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: � Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip. Phone:
MORTGAGE COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 ail 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.
Signature of Owner k s Re Contractor as Agent for Owner mature of Contractor/I IrpnvwF:P r for
STATE OF FLORIDA,,,', ,
COUNTYOF " ;. STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of n 20 l"f by
(Name of person acknowledging )
rr-
(Signature of Notary Public State of Florida)
Personally Known :-;!*g'= j Pr&ARW6sJ tlfkAf Z
Type of Identificati Commission # GG 97150
a y omm�sslon xpiru
Y�°4o,n S 2021
Commission No.
Apr1 24 'iiccrrnn
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
The forgoing instrument was acknowledged before me
this day of 20 1'r') by
(Name of person acknowledging )
(Signature of Notary Public State of Florida) n
Personally Known rrr".":jb<t Prcppleit�dtQEZ
Type of Identificati "'o d Commission # GG 97150
°*
My Cornmisskon xprres
Commission No. %r;'iit`° April 021
SUPERVISORPLANS � VEGETATION SEA TURTLE ! MANGROVE
REVIEW REVIEW REVIEW REVIEW j REVIEW