HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFr MUST
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / .,,Permit Number: - �✓ 2- �
=8 m AWN
Y 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 l
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRQPO5ED fMPRov MENT LOCATION
-
Address: l'
Legal Description: IV 4-(-Z .S° , • i f j � cU i
Property Tax ID#: 0.3) 2 J C� `f' - Ono 2--r;,C� 4 Lot No.
Site Plan Name: Block No.
Project Name:_SC
Setbacks Front Back: Right Side: Left Side:
'f
DETAILED DESCRIPTION;OF 1NORK
CONSTRUCTION IN!F-, MATZO I y f h
itiona workto enertormeaunder t ispermit-c eck all thatapply:
Gas Tank ❑
11HVAC Gas Piping L_I Shutters E]Windows/Doors
Electric 0 Plumbing Sprinklers MGenerator oof
Total Sq.Ft of Construction:/ S .Ft.of First Floor:
Cost of Construction:$ 1 �i ���/ Utilities: Sewer a Septic Building Height:
OWNER/LESSEE -
CONTRACTORS
Name 1� !� Name: �9
Address: Company:
City: - State: Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No. -S
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.
+ i
SUPRLEMENTAL`CONSTRUCTtON Li'EN 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 recordina vour Notice of Commencement.
_Signature f Owner/Lessee/Agent Signature of tractor/License Hol er
STATE OF STATE OF FL
COUNTY OF FLORIDA 4/U/4 VT COUNTY OF ORIDA Aw
The forgoing instrume t was ac nowledged before me The forgoing instrument wa acknowledged before me
this y of 20 �by this ay of �"+ .20 LIZ by
7S I/ ' ' '
;4 Wc e a�f"�
(Na " of p rson acknow dging) (Na er on acknowledging)
40
(Signatur of Not r �Publicc- tate of Florida) (Si na f N ary ubl' -State of Florida)
Personally Known � OR Produced Identification Personall Known OR Produced Identification
Type of Identification PMROYDV
Type of IdentificT
ell
Commission No. e MPTON Commission No. ROY�� MPTON
blState of Florida tary Pub is- late of Florida
ission#FF188186 Commissio #FF188186
ss ,
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS