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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: / -�� Permit Number: s _ ouiming r@rmix ApplICavon Planning and Development Services / Building and Code Regulation Division `'✓// 23oo Virginia Avenue, Fort Pierce FL 34982 Residential Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial PERM I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line pRopUSEU IMNKOVEMEN 1 LUCAI ION: -- Address: Legal Description: Property Tax ID Lot No. #: �yd � � � Of�r�y —� Block No. Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: O - IAILED UESCKIN I ION OF WORK: 10A CONSTRUCTION INFORMATION: aV, AC L] Gas Tank LJGas Piping LJ Shutters 11 Electric 0 Plumbing Sprinklers Generator Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Y � Vq Utilities: []Sewer 0 Septic OWNERAESSEE: Name Wi '"" ' Address: u O �� � ��a't-�Q•- ' ``� State: FL— City:Zip Code: 3 U� S L Fax: Phone No. 4b5- i ©� E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: QW indows/Doors F]Roof Roof pitch Building Height: Name: C u (L' ` ,SN rilDv\c; (7 yu �ISC, Company: C -Tc m A , c P{hts Address: �� 15 1�� I [ CiG -t { f ee i1 City: ipc% 2T St . C u c e_ State::E Zip Code: � `f-4 52 - Fax: '1 `7J 3 <S- { q Phone No. -7,13- 335- E -Mail: 35E -Mail: CLz g c- &01 State or County License: If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. IS}I 0525!6 !21 3arkw SUPPLEM EN I AL CONS I RUC i ION LIEN LAW I NFORMA I ION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: — Not Applicable BONDING COMPANY: _Not Applicable i Name: Name: Address: Address: City: City: Zip: Phone: Zip: Phone: 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 Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such which is in conflict with any applicable 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 exemptfrom 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 your Notice of Commencement. i s Signature of Owner/ essee/Contractor as Agent for Croner Signature of Contra or/License Holder STATE OF FLORIDA / STATE OF FLORIDA COUNTY OF COUNTY OF The instrument was acknovrledged before me The forgoing instrument was acknowledged before me 11 by this !'� day of �A /✓ 20 IJ this �7 day of 1 /� n% 20 eurbs �14fri Mon E cf"TI 5 �%4YVilmon S (Name of person acknowledging) (Name of person acknowledging) GrI , (Signature of Notary Public- State of FI a) (Signature of Notary Public- Stat of Flori Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification Type of Identification Produced Type of Identification Produced Commission No. U t C, OU 7l� ra 0 RI5 W B mission No. Lit & V * * rc , MYcoL9A S=N5 052516 _• o; :' i * EXPIRES_April , 202t r •gam -- i Batled Thu Binet NafrY Sorbs � ,•"- ; oIR * * MyC0MMWW#GG00W Revised 07/15i2014 � �� UPAMAM4,21Rt REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE i I N ITI ALS IS}I 0525!6 !21 3arkw