HomeMy WebLinkAboutBuilding Permit Application e I 1
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 2'� Permit Number:
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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 Resl.denfial _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PROPOSED.IM,PROUEMENT.LOCATION
f Address: �►�L � sor I,' I
Legal Description: S,D4Aj Ls 14 ZA Kee P54/ (Z L-U4 y �I
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Property Tax I D#: /®� dR�� Lot No.
Site Plan Name: FJv� bc.Q Block No.
Project Name: i I
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK
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CONSTRUCTION-INFORMATION
itiona wor to e e orme un er t is permit=.c ec a t t app y:
HVAC Gas Tank ❑Gas Piping Shutters I
p g _ � Windows/Doors
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Electric F1 Plumbing Sprinklers Generator toof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction: $ 27 Utilities. Sewer Septic t Building Height:
OUVNER/LES S CONTRACTOR ,? :
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Name J 0e>,,$4l O Name: 4G40i_ e &P—GRZ3GCll i Y
Address: �t L Company: E06eiP I'j A CS 0
City:-- P / /Z.eIe State:_ Address: 70 6,b
Zip Code: Fax: 1 City: U-) P II./ 1 State:
Phone No. :27 2. J!!;6 f� 3 2 Zip Code: _�.3 7 ��I / Fax:
E-Mail: --- Phone No
Fill in fee simple Title Holder on next page(if different E-Mail: o1'2i �/w Gf u+�Q6'��u "T
from the Owner listed above) State or County License: I��C a el I V _31
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. '
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1SUPPLEMENTAL CONSTRUCTIjON LIEN LAW INFOTRMATION
'DESIGN ER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: } Name:
Address Address I,'
City: State: City: f: I State:
Zip: Phone: Zip: Phone;:I
FEE SIMPLE TITLE HOLDERin _Not Applicable BONDING CO !A _Not Applicable
Name: Name:
Address: Addresses f.
City: City: I '
Zip: Phone: Zip: ,Phone:'
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 bbild the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenant's that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any rest's fictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,ini 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,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 t inspection. If you intend to obtain financing, cons th!lender;or an!attorney before
comm cin rk or r ordin our Notice of Commencement
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Sig ur of O ner/ essee/Contractor as Agent for Owner ignat a of ontracti r/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF G GC �'( � COUNTY OF
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The forgoing instrument was acknowledged before me The forgoing instrument was'acknowledged before me
this 2Zday of re 8 20 Lay this Z2day of 'F7(0103 i,20 by
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( n acknowledging (Name of person acknowledgin I
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(Signature of Notaryy Public-Sta Sin of IN Vubiic-, Florida)
Personally Known 7L OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
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'DEBOitIWRl1E� �`::�•'' DMORAHPAE00Ut W
Commission No. Commission No. I ioaf9t��e
ay < Expires Jlme 15,2021VW
';� ��< eExs Juni 1fi,�021
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION- SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE j
INITIALS
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