HomeMy WebLinkAboutDocument (16)ALL APPLICABLE 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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
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Address: qsm
Legal Description: _ .�VL t Y A (� M l �i ±
Property Tax i[
Site Plan Name
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: -
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CONSTRUCTIONIN
AdRd.4on5lwork to be e arme _un er t is permit — c ec a app y:
tlVAC Gas Tank ❑Gas Piping Shutters ❑ Windows/Doors
Electric Plumbing Sprinklers E]Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor: _
Cost of Construction: $285 e Utilities: Sewer Septic
Building Height:
OWNER/LESSEE: _
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CONTRACTOR:
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Name LaName:
GACZ
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Address: r 1
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Company: r
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City: San
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Zip Code: 3S Fax:
City: _ St1�•l'1
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Phone No._ff "lC.� — 0.L(.' o _
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Zip Code:
Flax:
E-Mail:
Phone No. CAM �)
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E-Mail:
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: C
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNE
Not Applicable
Name:
Address:
City: State
Zip: - Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY:
Name: _
Address:
City:
Zip: Phone:
Not Applicable
State:
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, 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 pra erty. A Notice of Commencement must be recorded and posted on the jobsite
before the first ins i `. If you intend to obtain financing, consult with lender or arlrattorney before
commencingwo or r ording your Notice of Commencement.
Signature QfPG-nerLessee/Contractor as Agent for Owner Signature of
STATE OF FLORID" / STATE OF FLORID ' r '
COUNTY OF c m COUNTY OF. _�2 �,
The fo �g instrument was acknowledg�e efore me
this 9 day of � k� ��, 20 by
(Name pqfson acknowledging-r7 w
The for Ding instrument was acknowledged gfore me
this day of (,J— 20`f by
F4) Ir— 8�_FHJ
(Nam_q ofperson acknowledgie�
(Snature of No ry blic-'State of Florida a ubflc—State of Florida)
P sonally Know O ifica n Personally Know OR Prod
Type of Ide catio FF 93 19 Type NBEFtG
005 vem � . n # FF 9354
Comrnssio
Commission N 'e_s u N_w Commission
vemberIi
9nnEidthNil%Fon�oata
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS