HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABW,INFO MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED. "
r 0& .r
Date. Permit Number: ` �f ` .
Building Permit Application
-Planning and Development Services21
..
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
P�oP®s�® IY :�PRo�u�t�IEI�1T LocATlorr.
Address: I„']�2� SAT( CI ADO ' FLU'D,. iie7I,r
Legal Description: �F�l 1L (�fs�t, c i'_.x t Lc cC
Property Tax ID'#: ? --I 'Lot No.
Site Plan Name: Block No.
Project Name:-
Setbacks Front. Back: Right Side:"` Left Side:
®E1�AtLEO DE�SC II'P1"IQ
�G rC.emo kJ(__-. " 5 ftvi& t5S
(�N AN 5 VWob(Vtems.. 19.( �u�c`��> a�s 11►z IPi�trc �2-��4-
C N I KJ it IaN ) f® t ATIQN:
Additional work to'be ne�torrfted under this permit=check allfn apply:
E1HVAC L__I Gas Tank ❑Gas Piping _Shutters ❑Windows/DoorsO
d�
❑Electric ❑ Plumbing Sprinklers; ❑Generator Roof y�(Z Roof pitch;
Total Sq. Ft of Construction: O- S�Ft.I of First Floor:
• Cost of Construction:$ 13 \C12rJ'"� Utilities: L !Sewer❑Septic Building,Height: 5�
Qx1NER LESS E• CO(UT'RAC OR:
Name e bbeyR_ C iC�.J l�_C, Name: i' Wit, -Ck< S �
Address: 79-1 (J L.LJD(4),� 11way, ]DW Company: Q�.,kA. E0Q�t,:z1 r CSC
City: T::t FI, (2i � State:L:7-L Address: 3?`1� p6e
Zip Code: 3A9Lf(., ' Fax: City: tt. cca)� Stater
Phone No. 1'�'Z Z(� q4 Zip Code:-3 Fax: ZZZ� (oL-foL J'�
�
E-Mail: Phone No.�'Z (OA::7
Fill in fee simple Title Holder on next page(if different' E-Mail:
from the Owner,listed above) State or County License: LO
If value of construction.is$2500 or more,a RECORDED Notice of Commencement is required.
SU.PPLEII�ENT�L C®NS 'REJC1'ION LI'�N Lp►W IN ®RIVIA►TI( N.
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: —Not-Applicable
Name: Igij bP;I;1rt,,j t-) Name:
Address: '22aos f✓L S c-1A Address:
City: State: City: State:
Zip: ajL% ?.z Phone:�7�, q(jj 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 an ted on the jobsite
before the first i e f you intend to obtain financing, consult with I e r an t orney before
commenci w k recor ing your Notice of Commencement.
s
Sign urd of wner essee/Contrac or as Agent for Owner Signature of Contractor/License Hol
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 _by this day of 20 by
i
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
CO M P LETE
INITIALS