HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO
/MLLST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: [ 1 —6` / / Permit Number:
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Building Permit Application
Planning and DevelopmentSer4ces
Building and Code Reguladari Division
ZW Virginia Avenue,Fort Pierce FL 34982 '"
Phone:(772)462-1553 Fax:(772)462-mss -Commercial Residential .
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED.IMPROVEMENT LOCATION:
Address: C' c :_
Legal Description: �o J �� g� 4� �1�1 a-9-SCLC. a c S�l cc, /1 r
Property Tax ID 0 G ` Q C Lot No. AD
Site Plan.Name: l�GyL s: i Ln�(Y)A. ! + Block No. I
Project Name:
Setbacks Front Back: Right-Side:• Left Side:
DETAILED DESCRIPTION OF WORK:
I
CONSTRUCTION INFORMATION:
Additional wom to a rme under is permit—� a appy:
1jHVAC Gas Tank 1�Piping _Shutters Q Windows/Doors .
L]Electric Plumbing [3Sprinklers aGenerator F1Roof
w
Total Sq.Ft of Construction: l Q .It of First Fioor:
Cost of Construction:$ Q� UtilitiesElsewer[ISeptic Building Height:
OWNER/LESSEE: CONTRACi'OR.
Name !tic i-A Name: C. A16 11 4C
Address: Company: E- k
City: . _hate:jt -( Address: IC03C to
Zip Code: 3Y?5_1 Fax: City: Pf- Statm-Ec-
Phone No. ;�7r` 1�-6 Trp Code:3 �(
E-Mail: Phone No.
AN in fee simple Tide Holder on next page(If different E-Mail: ear d
from the Owner listed above) State or Countoilcerwr.
ff value of construction Is$2500 or more,a RECORDED Notice of Comnrenoement is required.
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DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:T City State:
Zip: Phone: Zip:• Phone:
FEE SIMPLE TITLE HOLDER:- _Not Applicable BONDING COMPANY: Not Applicable
Name• Name•
Address: p Address:
City: City:
Zip: Phone: Zip: Phone:
1 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 1 will,Wall 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,screewroom�.and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your�wying twice for
improvements to your prQperty.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. -
Sign re of owner/Agent/Lessee Signature of contractor/License Xolder
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF _ COUNTY OF
The f rgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this�day of t ' - ,-2q�by �'1 this�day of (fid .20�'by/'
(N4fik -
meperson acknowledging) (Name of person admowledging)
Wignatdre of Notary Public-S of Florida) (Signature of Notary Public:Stat Nof Florida) -LA",; NiiP1A IPiG iAi�1
Personally Known OR Produced Identification. Personally Kno Rko ypay``° l of to c a
w� ° ' R P.rtlduced Idet�`Hfi
Type of Ider>tiflcationfroduced- "`Q Type of IdernificatN Comm-Expires uec 'AO
W`—` ;
Q Commis5:a# �; Notary Public State of Florida ,• lion Notary Assn.
Commission No. 3 - bonded ta�} ,
My C04WII�ires Dec 20,2018 Commission NO.
".° "o;= Commission#FF 177249
"'"�OF FI�.� A otary Assn. .�
Revised 07/15/2014
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DATE
COMPLETE
INITIALS