HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE tNFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ua45 Permit Number:
0
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 line
PROPOSED IMPROVEMENT LOCATION:
Address: m ?vark_
Lega I Description: C-or sl ave, Oe dto in arae. f t1 k I Lf f 321 3 fci4 ''rZ W
PropertyTax ID#: �� �. �]C3�'" ��� I - �'� Lot No.
Site Plan Name: Block No.
Project Name: -\a,M P_ i G(3f1
Setbacks Frontt J Back:15�Right Side;-t�Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit-check all apply:
HVAC Gas Tank ❑Gas PipingShutters a Windows/Doors
_
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: iS6 _ S . Ft.of First Floor:
Cost of Construction:$; C)0�� • nom_ Utilities:,nSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name e.
,e Name: e
Address: Q Com
P an Y`
City- i State=r__I_ Address: ��
f
Zip Code: Fax: City: (1r*t'�t C r C� State
Phone No. -- Zip Code:&l 9-In ,= Fax:
E-Mail: Phone No.1-9- 2-a246
Fill in fee simple Title Holder on next page(if different E-Mail?.
from the Owner listed above) State or County License: : , 1 7
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.'...:
� r
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Ap licalIble MORTGAGE COMPANY: _Not Applicable
Name: r 1 Name:
Address: Address:
City: br-k ,--A - Uutl State: City: State:
Zip: n 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
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 Commencement.
. � � s
Signatu of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
S E OFA QA STATE
COUNTY OF � COUNTY, � � OFOFI
l a
The fo going instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofo( 's( 20by this A;day ofocQi (,_n 20 by
1
person acknowledging) (NaM-e—W, erson acknowledging)
aA V
(Si ure of Nota Pu lic- ate of Florida) ( %nature of Notary ublic-Sta of Florida)
Personally Known OR Produced Identification Personally Known_OR Produced Identification
Type of Identificati nd Produced Type of Identificati6n Produced
Commission No. Commission No.
"wt'+P•••,, DMYEL JONES ••Ky'Y•' DANYEL JONES
W COMMISSION 0 FF 198907 i = MY COMMISSI Y FF 198907
EXPIRES:June 12,2019 a EXPIRES:June 12,2019
Revised 07/15/2014 ~ Rr„h Bonded ThruNotary Pub5cuoaerwrites '•�;R;;�° Bonded LawNoraryPubGaurdemb(e
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE j fmk -I F_
INITIALS T At ,
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