HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: Ca1.�
��1 �� Permit Number.
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Building Permit Application
Planning and Development Services 2019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Resi -
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at-the end of line 7T_h
PROPOSEDIMP.ROVEMENT LOCATION
Address• .�j I
Legal Description: d o o 1" Tito 0
Property Tax ID#• Lot No.
Site Plan Name:1 I (� L, L F,4 id%' (Ai t�4"T Block No.
Project Name-
Setbacks Front Back: Right Side:.- Left Side:
DETAILED DESCRIPTION "OR
CONSTRUCTION INFORMATION
AddMonalworKtobenertormed under t is permit—cheCK all that appy:
C]HVAC IJ Gas Tank _ ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: t1g Scl.Ft.of First Floor:
Cost of Construction:.$ Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR = :
Name 1 �1�V e f1V'� Name: ck
Address: 4 Company: (
Gty: Y1`e State:_ Address: 03 Ec&vf�
Zip Code:�� 7 � Fax' Clty: Pf I ��i_ State`
Phone No. Q '"'F-tL� — ®�' Zip Code:,W - Fax:I
E-Mail: ( Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or Coun 'cense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNENGINEER: Not Applicable
7MOR
TGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
Crty: Stade: CRT. State:
Tip: Phone: _.__rr Zip: Phone:
FEE SIMPLE TITLE HOLDER:- ' Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address- Address: '
Coll: - C[tY- - -
Zip: Phone: Trp: Phone:
I certify that no work or installation has commenced prior to the Issuance of a permit
St tucie Coonty makes no rep tion#hat Ls$ranting a�zermitwill airdwrizethe perm t holderto thesublect structure
which is In corhflict with a appl a Home Owners Asses on rules,bylaws or and covenants that may restrkt or prohibit such
structure.Phase consult your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested perni t,I do hereby.agm that I well,in all respects,perform the work
in amwdance with the approved plans the Florida Bullding Codes and St Lucie County Amendments.
ThefoltowingIn ilding per mit applications are exemptfrom undergoingafull concurrency review:room ad(0=4
accessary structures,swimming pools,fences,,walls;signs,scremmomvand accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result In yohir.-rayirhg twice for
irnprovernent s to your prriperty.A Notice of Commencement must be recorded and.postad on the jobsite
® before the first inspection.If you intend to obtain finaj!Ong,consult with lender or an attorney before
commencing work or recordinst vour Notice of Commenceme .
41' ye
Si re of Owner/ t/Lessee Signature of Contracsoi/license Holder-
STATE OF MRIDA STATEOF FIDRIDA -
COUNTYOF -e COUNTYOF
The forpoft Instrument was adamwle�dged before me The �nB ►sb,.'u�d�hent was aclmowledged beforenm
this'X°. clay of� w�e` _ - .-20�by this fiday orf_J \l-1\ 20„A by
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Pfaineof pemon a i�mawkW tQ�rrr��iiir .°...r• Acme �Ied W
!!�•`��'+�v++mss iaii.Y.ff..l.�.Y.11 •'b Y ]� 1�7Q�`b
(Signature of Notary lic Staate of Florida) (Signature of Notaryblk-State of rtcrWa j
PersonallyKnown OR Produced Wentfication Personally Known . Oducedllderi R{
Type of Identification Produced 1. Type of Iden,fication - 0,
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Revns 07/1512014 ' a,.de .
REVIEWS FRONT ZONING r� SUPERVISOR_ PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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