HomeMy WebLinkAboutBuilding Permit Application ALL APPLIIC BLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: opm Permit Number: [ ,
Building Permit Application
i Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL!34982
;Phone: (772)462-1553 Fax: (772)462-1 78 Commercial Residential
PERMIT APPLICATION FOR;: To Select from dropbox, click arrow at the end of line
P:RO,POSED.:LMPROVEMENT LO�CATIOsN
Address:
Legal Description: � �r' � dc)L) L-S
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Property Tax ID#: "7 V ® C) o Lot No.
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Site Plan Name: ! Block No.
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Project Name:
;;Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION 'OF WORK
1-1 L4— 6 L/-S 4-r— 1%a-P A,'
CONSTRII -TION INFORMATION.
AcIclitional work to be Derformed under this permit-check all apply:
1HVAC El'Gas Tank Gas Piping lShutters QWindows/Doors
Electric Plumbing Sprinklers enerator 1:1 Roof Roof pitch
j Total Sq. Ft of Construction: S . Ft.of First Floor:
K110-0
Cost of Construction:$ 0 Utilities: _Sewer F�Septic Building Height:
ODUNER/LESSEE ` -r CONTRACTOR:
Name Name: ft( "onAD ` la1 al'k-
Address: �%! �do c•,� L JA-`' Company: FI N/ 4&s •Ou[A x-,uC.
City: -&nI,-t. State: Address: ( �•L 14c, +""��G` ��
Zip Code: oc r1 Fax:
Phone No. City:��%St$in1 ✓�i t.� State:
Ji - � Zip Code: ZA99_3 Fax:
E-Mail: Phone No. I (f) —A I ka
d gel
Fill in fee simple Title Holder on next page(if different E-Mail: F i' )y ha6 r yc_WcfyG
from the Owner listed above) State or County License: 3
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTROtTI0N,LIEN tAW INF.,ORMATION'
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zilp: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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I certify that no work or installation las 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 HI me 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
:before
work or recordini vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as gent for Owner Signature of Contractor/License Holder
IISTATE OF FLORIDA STATE OF FLORIDA
COUNTY OF „� COUNTY OF .�a.��•�
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I -The forgoing instrument was ackno i wledged before me The forgoing instrument was acknowledged before me
this day of�@ b 20 aby this_L_day of 20 by
0/X uo�
(Na of perso know ledging) (Name of pe acknowledging)
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atuille of Notary Public-Sta of Florida) ignature of Notary Public-State Wlorida)
Personally Known CQWIRuce rsonally Known ifYeatr
LASHAHNA INGRiiRf "� A HAIiNA INGRA
Type of Identification Pro cep,+++++++,, pe of Identificati
Notary Public-state o id ;a*`�/r�r,b� NIItary 13u o iaa
Commission No. -.; '�» mksf r.Expires Dec 20,20 B mmission No. y: trl p Pc My Comm. p�tiraes Dec 20,2018
Commission FF 177249 E Commis FF 177249 t`
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Bonded through National Plotary As n. Bonded through National Notary Assn.
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Revised 07/15/2014 r�
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I �
COMPLETE
INITIALS