HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:' Permit Number:
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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
PROPJ,OSED IMPROVEMENT LOCATION:
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Address: 33s $6 TY'r,,y1!gLJJ ¢1 ice. Oork 5k b,jue., (4 34` Y'3
Legal Description: 9 Avt' VAO -Uki,k 4 bW '3 t Lok 6(
Property Tax ID#: 3Aiai- 5-30 - 013'+- ODOZ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTION INFO;RMATt:ON:' _ _,
Additional work to be pertoFmed under this permit-c ec a tat apply:
HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generatortoof Roof pitch
Total Sq. Ft of Construction: 1.400 Sq. Ft.of First Floor: 144Y
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE CONTRACTOR::
Name "(✓r'1AA Vilkaa> Ykmnfts n(JAei. Name: J is !� 40 Laffc,
Address: 33 SE 22riq,nl)s A..- Company: Ot-l-e- I-OnAhg S6l;1cr" r-te-
City: 0,1`k sk tcuac. State: Address: WedlK Ak.
I Zip Code: T:41 S5 Fax: City:- 5.kUr.rk-- State:,,
Phone No. '— Zip Code: 349-t4 Fax:
E-Mail: — Phone No. Wz iR3_49"s3
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Fill in fee simple Title Holder on next page(if different E-Mail: 2-1 1.cg2,y,
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
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.
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-Signature of 0 ssee/Contractor as Agent for Owner S gnature of lcense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF YnAyly) COUNTY OF YYW1 -+M
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1, day of ja'ylurt(4 20(2-by this a day of Q VA 20 Xq-by
(Name of person acknowledging) (Name of per n acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known n OR Produced Identification Personal) Known Se--) Produced Identification
Type of Identificatioh Produced Type of Identificati nd Produced
Commission No. (Seal) Commission No.
,aY>�,;% THERESA DE RITA
•�Y P�. ; ;�4 "__ MY COMMISSION#FF 062929
;A MY COMMISSION#FF 062929
Revised 07/15/2014 a= EXPIRES:October 29,2017 q�, Bonded Thru Notary Public Underwriters
Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
j DATE
COMPLETE
INITIALS
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