HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAIBLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1� ^� %
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Building Permit Application -01s
Planning and Development Services
Building and Code Regulation Division , Permitting
2300 Virginia Avenue,Fort Pierce FL 34952
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ResidentialC�vA,6
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line W'N"ta rL
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Property Tax I D#: ��a►- �C)"0®�a'��` Lot No.
Site Plan Name: Block No.
Project Name: f1 cc
Setbacks Front Back: Right Side: Left Side:
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Additional work to be erformed under this permit—check all appy:
7HVAC Gas Tank Gas Piping Shutters [Erwindows/Doors
IElectric ❑ Plumbing Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ l a"ja 7,�3 Utilities:Cn Sewer o Septic Building Height:
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CONTRACTORr � ,. 3 �i
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Name
1�- 05rnG.5 P�cc�..��.lS�- Name:'..;�;_�r PS��c:�.;"�� ��a i�.�'e S-t e c
Address: tQ70 C-�y,- k/ _Lk)ca,7e_) Company: f-'�- -, Oc"c-r'
City:aorct , n State: Address: 1.S a Q 1 "-1!•T-H 01
ZipCode:3 7 Li CUR Fax: City: 1-0,4'17�i l State:__F_1L -
Phone No.I- Gi-IR,Q i -R?,'7 5 Zip Code:JSLl I a_ Fax: SJ-1fU5-
E-Mail: Phone No. 5-6 1- S- o
Fill in fee simple Title Holder on next page(if different E-Mail: �,
from the Owner listed above) State or County License: L 6--) l- c��c��s 11
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
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.
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
improve s t your propert A Notice of Commencement must be recorded and posted on the jobsite
befor a firstY
specti n. If o intend to obtain financing, consult with lender or an attorney before
co encin wk or a or In our Notice of Commencement.
S
6ignature of Owner/Lessee/Agent ZWature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO DA r
COUNTY OF h6 OW Qr Ca COUNTY OF n Ilm Bog aC l�
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged b fore me
this_Q day of C1c t o b e r , 20 19_.by this:day of ��()(/ 20 by
0, l7of l�_5
(Name of person acknowledging) (Name of person acknowledging)
(Sign re of N to Public-State of Florida) (Signat a of Not6y Publi State of Florida)
Personally Known V/ OR Produced Identification Personally KnownOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. -1C W)2 (Seal ,Commission No. <PRYrue�,� (S&I�YOUNG
MELISSA GARW * MYCOMMISSIONFF951069
.�`�s�►''�. I&
w e EXPIRES:Apri112,2020
¢= L o� BondedfimBudpetNotarySaMces
Revised 07/15/2014 `� •= Commission k GCi OFF
pJres
s,.q ter?; My Commission 2 !
October Ot, 2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS