HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FORAPPLICATION TO BE ACCEPTED-
Date:
Date: Z Permit Number:
Building Permit Application @qAY
Planning-and Development Services p1R.U1ING =
Building and Code Regulation Division of Coup�'"± j
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553"Tax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED:1MPROVEME.NT:LOCATION
Address:` .rS c3 f�l /3:4 s ' �1;��2t'/ 1
Legal Description: 7 3'q 461 S
3. 1
Property Tax ID#: y o Ll a ou o ( Lot No.
Site Plan Name: Block'No.. , .
Project Name:
Setbacks Front/ _ Back: dr�o_ night Side: :Left Side:
;DETAILED D'ESCRIPTION'OF'WORK
5e� . -
CONSTRUCTION INFORMATION
Additional work to be nertormed under this permit check p all apply:
C�HVAC Gas Tank'.':_.'
Gas,P.iping _Shutters E]Windows/Doors
Electric Plumbirig Sprinklers E]Generator F Roof_ Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ h 37, Z� Utilities:�Sewer E]Septic, Building Height:. -
OUVN A LESSEE: CONTRACTOR:
Name flITOW`. MWA,4 Name: 3 •ef Q'
Address '6�WABALD C'i�l`fQI:SS —r _ Company :
City: .' %?•`�P1`. State: - AddressYc�a . �" �I'r C u ( � �I e t
Zip CodeQS] -Fax: City tf��i State:fi'
Phone No. 77,'1'a3,3-99,7E Zip
E-Mail: Phone No. 77 2- ( (
Fill in fee simpleTitle 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.
SUPPLEMENTAL CONSTRUCTION LtfN,:LAW INFORMATION::
DESIGNER/ENGI EER:_% Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: —I. c.-✓ fA1eer)o- Name:
Address: �'�F si-1 L Address:
City: ` 6R State: City: State:
Zip: 339 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 recordihizvour Notice of Commencement.
S
ature of Owner/Lessee/ ntractor s Agent for caner Signature of Contractor/License Holder
STATE OF FLORIDA M STATE OF FLORIDA�Ln
COUNTY OF I 4Q.,Ir�lit) COUNTY OF rrll
The forgoing instru nt was acknowledge fore me The for oing instru ent was acknowledged before me
thi day of 20" by this day of _1rl ( 20 a by
7Af)YI C.
(Name of erson ack o d ng) (Name of,person acknowledFA9)
(SignWaKnown
ta u ic- ate of Florida) (Sig tur Notary Pub a of Florida)
Perso OR.Produced Identification Personally Known OR Produced Identification
Type ation Produced Type of Identification Produced
Commission No. Commission No. "�'6v'• L7HIX Ai0N
`Qti�'r'°$ BRENDA L THIXrON ;.c,
MY COMMISSION#FF 057191"
L; EXPIRES:January 25,2018.
`•,' �' :o,° EXPIRES:January 25,2018 ay ,,' Bonded Thru Notary Public Underwriters/
�• .�:P.
Revised 07/15/2014 . Q,: Bonded Thru Notary.Public Underwiters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION- SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW'
DATE
COMPLETE Y 1:
INITIALS �. ,.