HomeMy WebLinkAboutBuilding Permit Application (2) 1
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ALL APPLjgABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j
Date: — -" Permit Number:] b na -C)6
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Building Permit Application i.,.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 I
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ! Residentlial V/
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the lend of line
PROPOSEDtI{UIPRQUEMENT LOCATION {{i �'
Address: u-11EWL WE (101 i E
Legal Description:S20XA(
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Property Tax ID M O 1 0 0 1 0 i Lot No.��
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Site Plan Name: i 1Block No.
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'Project Name: G aho AL
Setbacks Front Back: Right Side: Left Side: i:s
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DETAILEDDESCR{PT{OIU
CONSTRUCT{QNAT{O.N �
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itiona work to be pertormed under this permit-check all that appy:
HVAC Gas Tank ❑Gas Piping _ShuttersW' dows/Doors
ElElectric 0 Plumbing Sprinklers Generator I �' Roof 3`t Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction: $_�I Se�®. DO Utilities:[:]Sewer[ Septic Building Height:
O\NNER/LESSEE `t�2�1 t . °=; CONTRACTORS
NameName:S � �1,
Address: -N �
—1 WCompany:p Y:
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City: 0%ea a State:lr� Address: O l�°
Zip Code: Fax: City: State.
Phone No.—I-7&I— 4 Lel—?J' ILAe d Zip Code: J 3 ! 1 I I ' Fax:
E-Mail: Phone No h 3 -`
Fill in fee simple Title Holder on next page(if different E-Mail: yf7
from the Owner listed above) State or County License: r ..
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. '
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Sl)PPLE�MENTAL CONSTRUCTION L[EN LAIN INFORMATIONE`5
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANYI• I _Not Applicable
Name: Name:
Address: Address: I
City: State: City: State:
Zip: Phone: Zip: Rhon `
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: ;;' Not Applicable
Name: Name: I i,
IAddress: Address:
City: City:
Zip: Phone: Zip: Phone
certify that no work or installation has commenced prior to the issuance of a permit.
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St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
j 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 all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
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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 anothe non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improveme o your property.A Notice of Commencement must be recorded,'and posted on the jobsite
before first nspection. If you intend to obtain financing, consu ith Ilender,�!or an!attorney before
com encin ork or rgcording your Notice of Commenceme I'
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Sig u e n r/Lessee/Contractor as Agent for owner igna r ontractor/Licen's'e Holder
STATECOUNTY OFORIDA S-T- 1"-P, COUN STATEY OFORIDA5 i,; e
The for oing instru nt was acknowledge efore me The fo! Ing instrumentff,,,��was�acknowledgedbefore me
this day of 20I by this 2 day of L J 20 �by
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0 6aciAlonk�,b(k(i J0 D,
(Name of per on acknowledgi (Name erson ac o le79g
ature of Notary Public-State o ture of NotaryiPublic-State of Florida
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Personally-,Known OR Produced Identification Personally Known !/ OR Produced Identification
Type of Identification Produced Type of Identification Produce! i
r► tN`Y MORA"RA)r
Commission No. DEBORAH Commissio "'► Seal)
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Revised 07/15/2014 !
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION,; SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ! REVIEW REVIEW
DATE
COMPLETE
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INITIALS
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