HomeMy WebLinkAboutBuilding Permit Application ALL 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
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: ' L, i pe,-J'( p1rZ.-C
Legal Description: i2 -�S 7S s `E � rift-) (J
NvJ C0( n cf I cat N �o QQ
Property Tax ID#: �L _ � ) 00 0 000 C, Lot No.
Site Plan Name: 1/ ��7 Block No.
Project Name: Is �' �rl r '�. nLx.—_,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
R � � r)j;;;W#3o -za.
` _ � cr c. R•-,�a,rc-do c� � ro C.C. °G'"" ` `h`t
[CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit—check all that apply:
CIHVAC Gas Tank Gas Piping _Shutters Pi
ndows/Doors
Electric 0 Plumbing Sprinklers E]Generator _Roof
o�
Total Sq. Ft of Construction: 3 '2---S 0 S . Ft. of First Floor:
Cost of Construction: $ ) � � C7� . Utilities: _Sewer _Septic Building Height: �3
t
OWNER/LI-ESSI E: CONTRACTOR:
i(Name t )Ci'Cil Name: _F3>rT-r f1�n ►�
Address: -3 f t' * ,i n Lo-CA Company: C 1 -C'C?
City:_i"V` �� ��- State:�L Address: JVVi ! S f\1 It l 1
Zip Code: C1 k-4 _ Fax: City:
Phone No. 7 Z � �t _3 Zip Code: �L�r�.5�2 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: CCC 0�321SE
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 Commencemen /f
s
_Signature of Owner/Lessee/Agent Signat f Contractor/License Ho er
STATE OF COUNTY OF FLORIDA �',6 R- COUNT STATE OY OF FLORIDAu"l I
The forgoing instrument was acknowledged before me The forgroing instrument was acknowledged before me
this S`=i day of 20- L by thisPL4?2ay of Q[-f V 20 t2 by
(Name of person acknowledging) { ame of person acknowledging
{Signature of Notary Public-State of Florida ) i nature of Notary 7OR
State of Florida
Y Personaff Known V wn OR Produced Identification Personally Kno Produced Identification
Type of Identification Produced identification Produced
•••1......
Y�p�q� AEBRA K EBN
Commission No. 'a�;. I)Notafy Public -State I 9€"i ion No. "VF' . J5Nt�1OeROAViS
Commission # GG 47893 ?*;' ,� My COMMISSION#GG953418
^' `�; M Comm.Expires No 15,2026 ;�, g February 29 2024
Bonded Ihraugh National Notary Assn. fFOFx°• Bonded 7hru Notary Public Unclenvrtters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS