HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (� ��1 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: j�ln
X00 O ✓\ (a �f
PROPOSED INPROVEMENT LOCATION:
r
Address: 6L6-0, `-' 0 r � CQ�
1
Legal Description: \�OoCG
Property Tax ID #: 7� — 0 170 1QLot No.
Site Plan Name: \N> pL W : L L�^P� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
S
CONSTRUCTION INFORMATION:
Additional work to be performed un er t is permitrteck all that appy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof 31h ?.Bitch
Total Sq. Ft of Construction: ISoo Sq. Ft. of First Floor:
1
Cost of Construction: $ S Qz, a/) Utilities: _ Sewer _ Septic Building Height: 10
OWNER/LESSEE:
CONTRACTOR:
Name
NamAM
Address:
Com
C, a
City State:
FFax: /r�City:State:�C�PhoneNo. �S—-17.Y6_9t7�1
AddrZipCode:�B95Jz�
Zip C� Fax:-33C�D�t(
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail S
State or ou ty Liccnse G<L
1C Z
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
-j��fVot Applicable
Address:
City: State:
Z%p: Phone
Address:
<<
City:
Zip: :Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
Address:-
Address:
City:
City:
Personally Known OR Produced Identification V
Zip: Phone:
Zip: Phone:
Pro ce
wwimcry wn r rwa,run /4rrrH7vt r: Apptacanon is hereby made to obtain a permit to do the work and installation as indicated.
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-aythorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws orand cooenantsthat may restrict or prohibit such
structure. Please consult with your HHpmme Owners Association and review your deed for any restrictions which may. apply.
In consideration of the granting of this requested Armit,`f do hereby agree that I wilt, in all respedts; 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 undergarrg,a full cortFurrency reylew: rnom additions,
accessory structures, swimming pools, fences, wails, signs, screen roams anitaccessory usestognother non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result Inyotu 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
com encing work or recordine your Notice of Commencement
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
Signa a of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF_ S`� ��•
STATE OF FLORIDA
LV
<<
COUNTY OF ��—
The forgo'ng Inst ument was acknowledge efore me
this �r day of 20�y
The forgoing Inst +moment was acknowledge before me
J�,"tC day QT ^
this of 20�y
_ tw _ Lct L
Name of on making statement.
'�+1N91A tires_ 1 J
Name of pe on making statement.
/
Personally Known-=- OR Produced Identification
Personally Known OR Produced Identification V
Type Ientificat n
e of Identific n
Pro ce
r uced�� .
(S# ure o a Florkls
P o a a
Commissio 100 �I
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Comm!ignat
Commisuono GO"
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REVIEWS
FRONT
ZONING:. `.
SUPERVISOR
PLANS
VEGETATION
SEA -TURTLE„ s-
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW s
REVJEW
REVIEW
,
DATE
RECEIVED
DATE
y
a e.
COMPLETED
%ev. 8/2/1/
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