HomeMy WebLinkAboutBuilding Permit Applicationi
ALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date: [ Permit Number:
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
r
Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ` ^� t {„ ' 4q5
Legaluescrlptlon: �Ir�O,n 1/M/AC ��/illfLi..i(iir.A �V�
Property Tax ID #: _ 2 Q'3i911. OO Z5 - 000-9
Site Plan Name: Lot No
Project Name: Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
(,I ICU for G ke : � [l r>eur � foh [ s�FIZ utm C I(q&
"it to/ ( 0 Kc i heat -
TION:
.w vuo pet Rll(—CI
_HVAC _Gas Tank ❑Gas Piping
Electric El Plumbing 05P rinl
Total Sq. Ft of Construction: �r�
Cost of Construction: )� $ "JW, UV
Shutters
Ns "Generator
Sof first Floor: _
utilities:Sewer ❑Septic
°t'' mt pifat,- State: l=l,
Zip Code:t�(ms Fax: 01A
Phone No. 00%' 27I -A 1-714
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
E]Windows/Doors
0 Roof
Building Height:
Address: $1 QS 1 obi (CQ
City: �(— Y� ce State: (+
Zip Code: L�Lrj[ Fax:T1;1 L&_3-737
Phone No. AL41
E -Mail: cy, —
State or County License: ("}n[$(a(g(,
If value of construction W$2500 or more, a RECORDED Notice of Commencement is
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 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 permtt nolaer w Duna the suolect structure
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.
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
Signature of Own@r Agen ee 041 Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA &I r t AIn i
COUNTY OF JI M10, COUNTY OF l rC/
The forgoing i m nt was acknowledged before me
this day of-�' 20 Wby CT -1
18
` MQ rkl(P_
(Name of person acknowledging)
K��L,&� ,e" -
(Signature of Notarylic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced - - od
„Commission # ro
My om
__._n mrounh Nabpna'
The fo going instrment wa. acknowledged before me
this �ay of � 20jor by or ..
it
U
(Name of person acknowledging) '
awwzaG
(Signature of Notary P is State of Florida )
Personally Known 15 R Produced Identification
Type of Identification Produced
CHRISTINE J. CONWfiIl
o ary u is • State of Florli
Commission N GG 017539
Boaaed 1Nougn Nal lona' Notary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS