HomeMy WebLinkAboutPermit Application LimbALL APPLICA L • INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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: O`T Ct (15 rr(k,( (,)
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Legal Description: 1�Tcxt-e - 4 fj � wee. Sy f v-c Cre-r } R
Property Tax ID#: 1301" Ell-bG(9-06O-q
Site Plan Name: 1 -,vv b
Project Name:
Setbacks Front 0 r d- Back: (4 r Right Side
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OHVAC
11 Electric
4` Left Side: _+ r
Uw 6xc 8 tjavd Fe,,*_ Wl i S' 6.r� 4 ( - w
ee pertormea under thus permit - ct
L_I Gas Tank Gas Piping
❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Lot No.
Block No.
in rrlr•
Shutters l] Windows/Doors
OGenerator 1:1 Roof Roof pitch
S Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name U t- r L clZ
Name: r ad�-
Address:_LI10? C,4rU!, Gr ,J
City: IF+ ,ecca State: eC-
Zip Cade: Fax:
Phone No.
Company: Uc cCCEwS Cnc.e c CS
Address: a1cic' Sow 63.n.4, J AJe
City: p5 L State: i✓
Zip Code: 3`f Fax:772_'o4'71•'1b0`7
Phone No. ??L' b?241
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: e+rrv�c tv qa vu • Corw
State or County License: COC -AY5� .3
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION;
DESIGNER/ENGINEER: Not Applicable
Name:
Address: 1
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City: pj
Zip: Phone:
MORTGAGE COMPANY: _ _ Not Applicable
Name:
Address:
City: U I It State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 the permit holder to build the subject 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, 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
commencing work or recordini7 vour Notice of Commencement.
Signature of Owner,
as Agent for Owner
STATE OF FLORI -,_ r
COUNTY OF �' C,� �, Ir�`� _
The forgoing instrument was acknowledged Pefore me
this � day of c��lr*' 20 jw�..by
1
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(Signature of Notary Public State of FI_c>0a ).Gq y55roy' r2
..L a�GdST 1.p
Personally Known OR ProduC d*I(er'�likation
Type of Identifica on Produced
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Commission No. d
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gyp' ,drys unde'c;' �QO
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Revised 07/ 15/2014
Signature of Contractor/License Holder
STATE OF FLORTILQC_�:ell
COUNTY OF
The forgoing instrument was acknowledged before me
this lj___ day of 3QN1t_ 20 M by
Ax
(Nam of person acknowledging )
(Signature"'of Notary PuKIic- Stalte of Flo—da
Personally Known OR Produdd dentific4tion •
Type of Identification` Produced &ZrI 0 13
Commission N ��cunaar+►i`:g�y SOP:
STATP 00,X§N��
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS
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