HomeMy WebLinkAboutBuilding permit appALL 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
Phor..?: (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.
----------- ---
Address:
Legal Description: Lu)p — YkIii );:1�61
C �_(5_0N A 1 " .-D
Lot No.�_
Property Tax ID #:
Site Plan Name:
Block No..
Project Name: UL�J
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
-
"`� `C9..� ��� � �,C � lam.► � — �.s,3 � �-��. �-�,�(� �.,li Y�(�. � � � 5�-�U' � '��S''
a d t� rima h
CONSTRUCTION INFORMATION,"AM,
Add work to erTormecT under mc this perYt - ec a apply:
��iti``ona
L=J+4-VAC Gas Tank []Gas Piping _ Shutters ❑ Windows/Doors
Electric ❑ Plumbing Sprinklers ElGenerator E]Roof
Roof pitch
Total Sq. Ft of Construction: _ S. Ft. of First Floor:
Cost of Construction: $ t, �� �� (�^: __ Utilities:CnSewer I Septic Building Height:
OWNER/LESSEE
CONTRA
Name
Name: v
Company:
Addresses:
Address:
City: State: i�A_
Zip Code: Fax:
City: J� (��
Stater
p
Phone No. ! �'- D63 Q
Zip Code: _33a-� Fax:
E -Mail: - -
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:m-so
f�k(-, Cbyk,\,
from the Owner listed above)
n
State or County LScense: Vie OS3�a
If value of construction is $2500 or more, a RECORDED Notice of Com rr.,-- n cement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zp: 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 thepermit 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: Yo
improvements to your pr
before the first ecti
commencing ork r
Signature
r a
uilure to Record a Notice of Commencement may result in your paying twice for
o y. A Notice of Commencement must be recorded d posted on the jobsite
If you intend to obtain financing, consult ith lend ' or in attorney before
rdine vour Notice of Commencement.
ctor as Agent for Owner
STATE OF FLORID!��,
'
COUNTY OF
The forging instrument was acknowledged b fore me
this � day of _-D � � f �(` , 20 �y
(Name of person acknowledgir _
(SiKnature of NW0y Public' State of Flo
rsonally Known
Type of Identif
Commissio f $`. x cti6%ves °t.,wFo,
Revised 07/15/2014
Signature e Holder
STA OF FLORID
COUNTY OF.
)�
The forgoing instrument was acknowledged before me
this �dayof JLnL'k�.4) 20 06 by
1
(NaMerson acknowledging)
( 'gnature of Public- State of Florida )
r
sonally Know OR Produced Identification
Type of IdentificaOn Produced
�— KATE
HRYN ROSENBE�RG
Commission No. "Y" mission# 415
�.
ember 11, 2023 :o_ Expires Nov �_:_ �.,,�me eoo•sss-lots
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS