HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -} ^2 /�
Date: S I / Permit.Number: I l C&Of`Y O
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 L Sh9�
PROP0SR ® I�MPRQVEI I ENT`L®CATION
Address: b CD ��-- �(-\ll U �`'� - �-� l t�2 � ,
Legal Description: ��� �Gt c_�tu rL-A V-10L,.,
Property Tax ID#: act ^ 000 Lot N
Site Plan Name: (Jk_AXg-2d'w�- � r r� ,r, OyA N\a�ny�C,V-1AM-1 Block No.
Project Name: ,�� t ,�,� C of�Y� -<,—
Setbacks Front .oZ 5 Back: �S Right Side: Left Side:
DE�T�AII_ED DESCRIPTI®N OF WORK: � > '
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C®NSTRU.CTIQN INF®Rf1/IATl,O'N: NMIgym.
Adaitional work to be nerformed under this permit-check all app y:
�HVAC Gas Tank Gas Piping —Shutters indows/Doors
_Electric Plumbing OSprinkl _Generator Roof Roof pitch
Total Sq. Ft of Constru '
Cos Wuettrn-$ , �-cE} Utilities: _Sewer Septic Building Height:
Name 1, I u SS Name:
Address: U(�j �_ V ,U o_ Ems— Company: U v. Y-vuy- S
City: State: ddress:-
Zip Code: Fax: City: L ate:
Phone No. Zip Code:2211�C�_,?t:::= F�arx: )}
E-Mail: G d.A[g,.L(1os.(0.),VAb- cyl an j , co vvI
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPRLEMENTA�LCONSTRUCfION LI�E�NI:AW IN,frF®. �( I�P►TI®{ t ^�
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.
s
Signature of Owner/Les ee/C ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,S\ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this � day of(_rApnP j-_ —, 20 D by this day of 20 by
"
(Name of person acknowledging) (Name of person acknowledging)
gna ure of Notary Public- ate of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
yp 0 (Identification Produced Type of Identification Produced
V
Commission No. (Seal) Commission No. (Seal)
LAW"a���u'� state of Florida
Revised 07/15/2014 ,��P Notary Public
'_; '• =pr,y Comm_Expires Dec 20.' "
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REVIEWS FRONT '� ''ZONING'0°rie SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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COUNTE �''REVI'EW` REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE