HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: 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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address•
Legal Description: �_
5
[680
Property Tax ID#: OD I Lot No. v
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK:
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CONSTRUCTION,IN_FORMATION
Additional work to be narrormed under this permit—c ec all t=appy:
HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing U Sprinklers []Generator Roof Roof pitch
Total Sq.Ft of Construction: �� So. Ft.of First Floor:
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Cost of Construction:$ 902 Utilities: Sewer U Septic Building Height:
OWNER/LESSEE CONTRACTOR '.
NameAdaM 4-T-3.11.f Name: Mck k n
Address: Company: 12 Qijaj!4, r
City: + w.;me- State:Ff., Address: Ing Cas—TC—Y4S-/
Zip Codey 95.1 - Fax: City: ELL iuffrcP State:
Phone No:-77a-c2 it — l P441 Zip Code: 3q 1?90 Fax:
E-Mail: Phone No.-77a-c95,a - 1-I9o-
Fill in fee simple Title Holder on next page(if different E-Mail: 0, , o�Com
from the Owner listed above) State or County License: aLo SCn
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION
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
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 thefermit holder to build the subject structure
which Is In conflict with an pplicable Home Owners Association rules,bylawsor aencovenants that may restrlct or prohibit such
structure.Please consult w�t�i your Home Owners Association and review your deedr any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that€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,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 POcordina your Notice of Commencement
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Sigdatte of Owner Lessee/Contractor as Agent for Owner Slgna re ofCoritractoPfUcense Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF -�. E COUNTY OF.
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j The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,--�€ day of M A2 20 i Eby this o27 day of i l tqk- 20 ,(..3_' by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known t/ OR Produced Identification Personally Known OR Produced identification
j Type of Identification Produced Type of Identification Produced
Commission No.&&D&W7_ (Seal) Commission No. U60-147 (Seal)
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GABRIELLE HICKS
Revised 07/15/20Iti, Q3:' MY COMMISSION#GG 069047
EXPIs ygOMMfSS1tN#GG 0694T
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REVIEWS FRONT ZONING PLANS VEC,� » III
• 6'i'deim7,Noar, undervfiters
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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