HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date: Permit Number: y� a 44
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: p as
To Select from dro box, click arrow at the end of line
PROPOSED'IMPROVEMENT,LOCATION:
Address: Q.'�C
Legal Description: Q- __� S S / : l ano /rl' .DP
LQk -3- Lc5S ,a f-T as 1A cA At la, a7S DA 3'�G- 76a
Property Tax ID#: XC/3 L/ " CQ 1 — a� �'( -- 06 3 Lot No.�
Site Plan Name: Block No.
Project Name: RIID» _
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to orme under this permit-check a apply:
OHVAC ff Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: 34 75/-1 S . Ft.of First Floor:
Cost of Construction:$ I ai y 00 Utilities:U Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name, Name: '-) C
Address: 1qGr ✓ , Company: •t'�, G /,�
City: �' State:�L Address: I W S ,
Zip Code: Fax: City: �C7Y a ��Gi1'C State: /el-
Phone No. Zip Co&: Fax: 3V3 �
E-Mail: Phone No. �e -3 7�1- 97 7 0
Fill in fee simple Title Holder on next page(if different E-Mail: / Cl tIC4 LZG IV q
from the Owner listed above) State or County Licenser, C`7
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 Commencement.
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Signature o Ow ess /C tractor as Agent for Owner Signature of Cont /Li en older
STATE OF FLORID STATE OF FLORID►
COUNTY OF COUNTY OF ��JlJ1 Gv P
The for oing instru t as acknowledged before me The for oing instrument was acknowledged before me
this day of 20)�by this jl day of j tt 20 J _?1by
IMF�.� �, � ��•-e
(Name of person nowledging) (Name of per acknowledging)
(Signatur a Public-State of Florida} (SIgnVr47df N6tary Public-State of Florida)
Personally Known OR Produ��c� c�;(de�jcation Personally Known OR Produced Ide��tfffl
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Type of IdentiflcaY n�6 Produced _h.�__��_r i ���. Type of Identificati nd Produced
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Commission No. � :°o S i4°�, =% Commission No. a{.)~`1 •2 � °
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REVIEWS FRONT ZOI�I��"&i""" SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS