HomeMy WebLinkAboutBuilding Permit Application I -
ALL APPLICABLE IN O MW BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ® Permit Number: 17 10
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 _
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the entl of line
PROPOSED IMPROVEMENT LOCATION: ;°1
Address qq G rA C cS "
Legal Description: G cc J c� !��-c� r "� 23�—
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Property Tax ID#: 0 I 1116 —V V d Lot No.�
Site Plan Name: a Block No. .
Project Name:
Setbacks Front Back: Right Side:' Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be nerformed under tispermit—check all it appy:
[1HVAC Gas Tank ❑Gas Piping _Shutters ]Windows/Doors
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Electric D Plumbing Sprinklers Generator E] Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
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Cost of Construction:$ (O �V Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
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Name r S Name: cQ vl-r— C
Address: Company: tc
City: 'e tateAddress: Z CO3 E rc fa
Fax � State:�LZip Code:
Phone No. Zip Code:5 LOF 6 I Fax: ?
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or Coun License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNE ENGINEER: _Not Applicable 7Address:
GAGE COMPANY: i _Not Applicable
Name:
Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:- Not Applicable BONDING COMPANY: ! Not Applicable
Name: Name:
Address: Address: '
Zip: City:
Phone: Tip: Phone:
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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 anyY 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 1 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,sc reewrooms,.and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your-oaying twice for
improvements to your prgperty.A Notice of Commencement must be recorded and posted on the jobsite
before thgfqst inspection.If you intend to obtain financing,consultwith I nder or an attorney before
commencing wo or recordingour Not' mencernent.
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Sign ure of Owner/AgeW Ceikee Signatu a of Contractor/License Holder
STATE OF FLORIDA }'w STATE OF FLORIDA cI
COUNTY OF Q j¢ z COUNTY OF
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The forg ' nstrument was acknowledged beft eme m The forgoing instrument was acknowledged before m
thisof - -20 6`.rib': this• I day of 6 C� I .26 by ,c
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(Name rson acknowledging) (Name of person acknowledging) >
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Si ature of Nota Pu is State olorida V (Signature of Nt)ay Public State of Florida
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Personally Known OR Produced Identification Personally Known f OR Produced Identificatio .;,;;��.•
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014 -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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