HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: �'`— — � 7 Permit Number:
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RECEIV7D APR �M 2917
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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 _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED I'MPR®UEMENT LOCATI®N:
Address: e0 O 1,n 4- YG 7:e Crl
Legal Description:
Property Tax ID#: 60 —616 7— OOO Lot No.
Site Plan Name: Block No.
Project Name: IQ
Setbacks Front.7 Back:Right Side: Left Side:
.DETAILED D€�SCR=EPTfON OF UVORK:
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.,C® STR}UCTIO'N INF®RMATION:
Additional work to e nertormed under this permit—check a apply:
11HVAC Gas Tank Gas Piping _Shutters .. []Windows/Doors
Electric El Plumbing Sprinklers El Generator E] Roof Roof pitch
Total Sq. Ft of Construction: w S . Ft.of First Floor: j
Cost of Construction:$ `7T�. Utilities: _Sewer Ll Septic Building Height:
®WN�ER/LESSEE:
Name i; 2 Y Na'm'e
t:•: u
Address: g�0 e0 tad _} ='Company; L ;i
City: r 7,ee State:t .� Addres"s': 17
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Zip Code: Fax: State:
Phone No. 772-- Zl w — `74/ 7 Zip Code: Fax:
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E-Mail: c/�i41���L/L A
/J(, 0,W Phone No.
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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SUPPLEMENTAL CONSTRUCTION LIEN LAW INF®R;MATI®N:
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 of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA izD STATE OF FLORIDA
COUNTY OF rZA-wi4L Wil/iF - COUNTY OF
The for in instrum was aG owledged before me The forgoing instrument was acknowledged before me
this day of JU 20 Qby this day of 20 _by
mar yG'(rti l Gl l h�ri�
(Name of person acknowledging) (Name of person acknowledging)
(Signature o Notary,Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known V OR Produced !der tiff at' n 11krida
ally Known OR Produced Identification
Type of Identification Produc r .�norin Tn�dcaTf Identification Produced
�;'pv
?,r•• �•�(Seal�ary Public-State of fission No. (Seal)
Commission No.� . ommissioQ#FF 941-,��; . My Comm.Expires.Mar3
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVI W REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE l
INITIALS