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 V%
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PsROROSED IMPROVEMENT LOCATION '' ry"�
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Address: rSQ�o 1U6r0J1 1 _ r0((�C &C S4C P
Legal Description:�"1 IMC <32%
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Property Tax ID#: 14eaS • �po3• QQ�Q�p4-000•`1 Lot No.__3
Site Plan Name-T-CfR 1 NaP',i! 0 t(X.Dc. St lfodl Block No.
Project Name:
Setbacks Front Back:Right Side,,-_""'-_Left Side:
DETAILED DESCRIPTION OF WORK t
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SIsJ��mll'1.
CONSTRUCTI;ON,INFORMATION
Add itiona I work toe e orme under this permit—check a appy:
HVAC E]Gas Tank Gas Piping _Shutters ❑Windows/Doors
11 Electric ElPlumbing Sprinklers ElGenerator ' 1:1 Roof Roof pitch
Total Sq. Ft of Construction: SCI. Ft.of First Floor:
Cost of Construction:$ Utilities:0Sewer 0Septic Building Height:
OWNERAESSEE: CONTRACTOR:
NamesX Name: itS
Address: 35 d 6 `mac Company:LtJ%l/ice,
City: 1=6AA f i ee-CP State:f2(.— Address: /e I Z 6 / d%XI /ArIvy
Zip Coder`�"1°I Fax: City: ;j &0� State:
Phone No. Zip Code: 32-q"�y Fax:
E-Mail: Phone No. '7 7 —77 7—J,d3.S_
Fill in fee simple Title Holder on next page(if different E-Mail: C/til 1q-e_-Co y Pal,),el-,`c•G., — S• Cati,
from the Owner listed above) gmMcense: e/9C O S 7 ZS I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN R/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: CM 07145 �_S7 Name:
Addres Address:
City: Stare:_'F1 City: State:
Zip: Loo Phone.-hn1--i—n.SS(o 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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tSi ` -ur. _ __.. essee%Contr_actor asAgent forOwner Signature 6f Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 0 - � &-
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The forgoing instru� ent was acknowledged before me The "rLoing instrument was acknowledgeflpefore me
thisi day of 20/,6-by this day of 20 /�by
(Name of son acknowle g) (Name of erson acknowledging)
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9—Y NAL��_
(Signa a of Notary ublic-State of Florida (Si ure of NoYy
Public-State of Florid
Personally Known OR Produced I tification__ _ Personally Known *W�I�ation
Type of Identification Prodg'�� Type of Identific yQTATFtY PUBLIC
NOTARY PUBLIC STATE OF FL
Commission N OF FLOAO1 Commission N F5M$0201)
Comm#FF99W11 Exlplro�
Exom 00—
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REV EW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE II
INITIALS