HomeMy WebLinkAboutBuilding Permit ApplicationALL 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 fine
PROPOSED IMPROVEMENT LOCATION:
Address: /Z,6 1JC//j�
Legal Description: /�1Kv !G{r C.�- 3 lvl<C 3 C ei f lV
Property Tax iD #: 377� ( i "
Lot No.
Site Plan Name: �G`'+'s�^�
Block No.
Project Name:
al ,/CC
Setbacks Front 3S Back: 4/ Right Side: Left Side: ft
DETAILED DESCRIPTION OF WORK:
/ws�411 aqx z,�ol
CONSTRUCTION INFORMATION:
-
Additional work to a er orme under this permit —check a apply:
❑❑Gas Shutters Q Windows/Doors
HVAC Gas Tank Piping _
Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
[]Septic Building Height:
Cost of Construction: $ z-3ba' Utilities:cn Sewer
OWNER/LESSEE: CONTRACTOR:
Name / Name: Ju
Address: /Zu �Jf Company: lit�C/Gti �c �-
City: State:rL Address:: Zluo
Zip Code: 3gl$3 L
Fax: City: I L_ State: —
Phone No. Zip Code: 3 z 7c,� s'3 Fax: g?��CDa !�
E-Mail: Phone No. Z`Z3��
Fill in fee simple Title Holder on next page (if different E-Mail: e-d/-e . Ct �4�rrka�o� 400. Gum
from the Owner listed above) State or County License: AC- W l®J�
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:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Pho e:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: 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, 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
commencing work or recording our Notice of Commencemen .
.0-1— S
Signature Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this � day of :,I;1 d 20 4h
(Name of persci acknowledging )
(Signature of Notary Public- Stati+-6f Florida }
Personally Known OR Produced Ider
Type of Identificat n Produced
Commission N f * (Sei
Revised 07/15/2014
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
STATE OF FLORIDA C
COUNTY OF J fi
The forkoing instrument was acknowledged before me
this � day of 20W by
(fume of person acknowledging)
y to e of NotaryPublic- State)bf Florida)
•.,, �� 4CiRK,�
12, so r lly Known OR Produced Id icatio
y Type l dentifecation Produced � �y
OGG093823 CP.R- ion No.LU1.
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SUPERVISOR I PLANS VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW I REVIEW
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