HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (ZI 12)1,R 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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: tole
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: i
Uka �lv ufa.: USJ-6L l htW ItAnOx A-5-bn, [ll S 661 slit- -sl stem AtFi&
UUi� Y� 8 VIA) huok .
I CONs;rRUC ION INFORMATION; III
MHVAC I _jGasTank
Electric 11 Plumbing
Total Sq. Ft of Construction: sS
Cost of Construction: $ 3100
6
Piping I I Shutters
nklers E] Generator
_ S�Ftj. of First Floor: _
Utilities: t iSewer E]Septic
0 Windows/Doors
1 Roof
Building Height:
OWNERAESSEE:
CONTRACTOR:
11
Name Wd V1Name:
Address: �� 9# `!/ off naL AVG
ckat( [ D
Company: BOV10-/
City: 1p�urb, State:
Zip Code: ,31i q5 ( Fax:
Phone No. 50 8 -,q:7:7 - 40 -Al
Address: 510 A (Wniae-
Ff_td
.
r
City: l'l Raw
Zip Code: .3'1451
Phone No. -17*1 {�1-444[
State: t .p-� Li
Fax:*M- b6b -373?
E-Maif:Nll,
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E -Mail: lonV(e at- tovajhn.cmrr__
State or County License:
eAC[ 3 f 3(? lP
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY-
Name:
_ Not Applicable
Address:
MANGROVE
Address:
COUNTER
City:
Zip: Phone:
State:
City:
Zip: Phone:
State
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Icertify 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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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, wails, 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
mmmencine work or recordine your Notice of Commencement.
Signature of Own Age�Lesse Signature of Cimtractor/Ucense Holder
STATE OF FLORIDA C(, I ,
COUNTY OF S L�&
The f��o��ggoing instrument was acknowledged before me
this i`21 day of L72P2W L% 20 1Yby
Mc�lae [ 6oy(a,g
(Name of person acknowledging)
Notary
Personally
Type of Idr
Revised 07/15/2014
Of
aduced identification
;JOL
STATE OF FLORIDA Cy
COUNTY OF U1 Wtt l
The forgoing instrument was acknowledged before me
this tl'It`�dayofJ�"--- 20_141 by ray
la
(Name of person acknowledging)
Personalty
Type of ldl
of Florida
wu"I 11s1on n oto
n �,k�"•°My Comm. Euires li.1PcCommission �cEixo_n nNe_s .EONddthrouyn National Notary Assn. MComm
Id
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through National Nolary As.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS