HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i1,•' Permit Number: �� "_' n 011
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
, ,RDPOSED.IMPROVENIEIUT L6tA,TION
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Address:
Legal Description:
61
Property Tax ID g: c�c7 'Jr�'� `'�Jr/ �'vCl�" Lot No.�
Site Plan Name: Block No.
Project Name: K
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4
Setbacks Front_ Back: Q_Right Side: Left Side:
DEFAILEDDESCRIPTION OF-WORk.
`CONSTRUCTION.INFORMATION
Additional work o e e orme under this permit-check a apply: ll
OHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
FlElectric 0 Plumbing Sprinklers C Generator FI Roof
Total Sq. Ft of Construction: W S .Ft.of First Floor: ' )7'
Cost of Construction:$ V� utilities.
Sewer Septic Building Height
OIN.NER/l€5 E: .CONTRACTOR: '
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Name Name: �
Address: Q Company:
Cityx�&_,w0 x!S-ah State: Address: f li Q
Zip Coe 3.3yQP Fax: City: State:
Phone No. / Zip Code: 1 Fax:
E-Mail* �� L� �fJp�St�!/ /' Phone No.4OZ—! 7 �BU sY 106_
Fill in fee simple Title Holder on next page(if different E-Mail: y�UW&Y&AfAl
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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SUPPLEME ITAL CONSTRUCTION'LIEN LAW,INFORMATION.,
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DESIGNER/ENGINFFR• Not Applica le MORTGAGE MPANY: _Not Applicable
Name: 4� Name: �t1
Address: Address:
City: State: City: State,
Zip: WG/ Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER- Not Applicable BONDIN C MPANY: Not Applicable
Name: A 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.
Gf/ Qt/ s
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID STATE OF COUNTY OF O
COUNTY OF
The&Agoing inst ent w acknowledged jlefore me The fogoing instr m t was a nowledg&by
fore me
this day of 20�(1 by this v/E7day of 20
( ame of person ackn wl Ing) (Name of person acknowleclginir
4
W I`tGU W / A&
(Signature of Notary Public-Utate of Florida} (Signature ofv ry Public- to of Florida)
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of Identification Produced ype of Identification Produced
T c ry ubPA State of Florlda
Commission No. �g Donna omrnission No. III
my Commission GG 092440 ��T ferry Pubic State of SONSExpire.0712712021 s DOnze
My Commission GG 092 a
Revised 07/15/2014 „n o7r17i2o21
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS