HomeMy WebLinkAboutBuilding Permit Application ; i
ALL APPLICABLE INFO MUSST, BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( f
Dater ��1 Permit Number.
RECEIVED
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Building (Permit Application
Planning and Development Services AUG 19 2020 t
Building and Code Regulation Division Permitting Department :i
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie coun it 4
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PR�PCISEDl1/IPR01fEiklCNT LQCATIQN
Address: T)n ,Or\ "PZy4r i�w, no—e/7 e.2tbk fe, Y1 I l
Legal Description:
Property Tax ID#: (j_ 15LI Lot No.
Site Pian Name: Block No. ,I
Project Name: -S(XX Ai it.2(`
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Setbacks Front Back: Right Side: Left Side:
DETAI�l.ED DESCRIRTICrN QF WQRK� � '.: _ -
�p0C,e, Ohs,
C{?NSTRUCTIQN INFORMATf3N
Additional workto (ee orme un er this permit check a appy
EIHVAC LJ Gas Tank E]Gas Piping _Shutters Windows Doors
RElectric FlPlumbing Sprinklers Q Generator Roof Roof pitch:
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Total Sq.Ft of Construction_--�— Sq.Ft.of First Floor:
Cost of Construction:$, / f Utilities: Sewer F]Septic Building Height:
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Namer,� Altiitzt _ ` �i r .i1� –{7t:1('_C)
Name:
Address: l?6-9 5C,( S- Ty1A',Gt-1 Utr k'!-,>Q. Company:_ 7LkCc, �
City: State: FL Addresst:- [Oil
Zip Code: Fax: City: State:l_L
Phone No. ��'a-�°�1 – 2Y3 Zip Code: SL(Ss,i-7 Fax:`n22 7 j'
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:i5er V;C
from the Owner listed above) ' State or County License: R(Y-1 [a I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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UPPLEMEI�TAL_COiiiSTRUCTIC�N I.IEi�I LAttU B'i1iF®RMATiC}N ;�`
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DESIGNER/ENGINEER: "Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TiTLE HOLDE • Not Applicable BONDING COMPANY: ____Not Applicable
Name: 'tA.4' Name:
Address: Address:
City: Cityy:
Zip: Phone: 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. i
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 l
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 ir,4ection. if you intend to obtain financing, consult wit ender or an attorney before
commencing ri(or ing your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Sig ature of Contractor/License Halder
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STAVE OF FLORID STATE OF FLORIDA
COUNTY C 6 WIN"IN COUNTY OF t11,k"(WYL,
The forgoing instrument was acknowledged before me The forgoing instrum nt was acknowledged before me
this day of 2Qby this 3C> day of __,20 / by
(Name o person acknowledging) (Name of person acknowledging)
(Sign ure of Notary Public-State of Florida} (Signat of Nota ubiic-State of Florida)
P sona�Know OR Produced identification Personally Know OR Produced Identificationppti�on__Produced ype �catian Produced
Commission No.lr^U� 4PUap 00 79 Commission No.O-A-1r yPuB(Seal)dENNAL.ERAnCO
lsslo�4 *o�:•••,t'c Commission#GG328T79
Comm t3 * Tres AP6 29,2423
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Revised 07/15/2014 OF
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS