HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �. %Z Permit Number: f �OrRECENED
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Building Permit Application
Planning and Development Services JAN e 4 2017
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: q`10 -e_ t-. 8.qqkl
Legal Description: 2ju '::T
3-i -I
934
Property Tax I D#:�Y!��J' �Z� cJ���' IJUIJ— Lot No.
Site Plan Name: Block No.
ProjectiName: r'� n j2.esu�,4yfn&.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ..4��{
�errc_& e tea" th.n rOoP o rnCLin houSQ _-
1- .(( a Dec Ira �Rq V I 10� , t� m>°,fa( .
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all apply:
❑HVAC Gas Tank Gas Piping Shutters ❑Windows/Doors
❑Electric Plumbing HSprinklers ❑Generator Roof Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor: �l26
Cost of Construction:$ ias� m_ Utilities: Sewer❑Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name Name: I
'2�
Address: 0 I,I. nalu _lam M• Company:
City:a . QIfmP State:i� Address:4d12
Zip Code:34RFC I Fax: City: State:-EL
Phone No. Zip Code: Fax:77Z 2.Sjro22,
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: •P 1l 0 Va k'@!2,0 •Ccx-Y,
from the Owner listed above) State or County License: (Ll_IA?0337
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LhEN 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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ignature w ntractor as Agent for Owner gnature of Con ense Holder
STATE OF FLORIDA STATE OF FLORID&
COUNTY OF MAI!n COUNTY OF ITWLV-')n
The forgoing instrument was ac_cK9powledged before me The forgoing instrument was acknowledged before me
this day of�(�gm"( _ 20 \6-by this'�day of Der- ,20 _[C by
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(Name of pers cknowledging) �, M: (Name of p on owledging) �,, M
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(Signature of Notary Public-State of Florid1',
2 a (Signature of Notary Public-State of Florida) a ,
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Personally Known OR Produced Idn "'m Personally Known OR Produced Identification �"'Type of Identificati Produced Type of Identifica 'onProduced
Commission No. (S Commission No. (Seal) {;
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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