HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE.INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: 1 �' �� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (172) 462-1553 . Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the. end of line
PROPOSED IMPROVEMENT LOCATION:
Address�J
Legal Description: �S 51---ma c � c� �Ac- ,3y��`I �Q t't ' R�
Property Tax ID #: Lot No.T3
Site.Plan Name: �S Block No. .
Project Name:
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
oC\x�s�
Aooitionai worK to De errormea unaer tnis permit — cnecK all apply:
�HVAC Gas Tank El
Gas Piping Shutters. Q Windows/Doors
IJElectric 0 Plumbing OSprinkle.rs F]Generator F-1 Roof
Total So. Ft of Construction: S ..Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer ElSeptic Building Height:
'OWNER/LESSEE:
CONTRACTOR:
Name t
Name:
Address:
Company:
City: State
Add fie s: SI�J v
Zip Code: Fair '�?J`t�l
City: �.� State:
Phone No. `�Izj
Zip Code: ����1� Fax:
E-Mail::
Phone No.
Fill in fee simple Title Holder on next page ( if different
from the Owner, listed -above)
State or County License:
— — 35
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:.
Not Applicable
'MORTGAGE COMPANY:
-'.Not Applicable
Narrie:..`�C-�C;1�s2,� .�-�ec�S'..
Name:
Address:6M �t,cAc�a
City:
C.�
State: t—
Address:. .
City:
State:
Zip:3y�5 Phone:.-a.�a•-
ti3�sei
Zip:. Phone:.
FEE SIMPLETITLE 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, l 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 ccncurrency review: room additions,'
accessory structures, swimming pools, fences; walls, signs, screen rooms and accessory uses tb 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 4Commencement .must be•recorded and posted on. the jobsite
before -the first inspection. If you intend to obtain financing, consult with lender man.attorney before .
commencing work or recording our Notice' of Commencement.
67
Signature Owner/ essee/Agent Si#Mfure of Contractor/License Holder'
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -mac COUNTY OF .erica e_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �r 20by: this day ofPtn . 20 Xa by
(Name of person cnowledgin ) (Name of. person. acknowledging )
(Signature of NotaryPublic- State of Florida) (Signature of Notary Public- State of Florida )
.Personally_ Known OR Produced; Identification Personally Known OR Produced Identification
Type of. Identification P oduced Type of Identifr,,, Produced
.,, pP r. ALB Sj� M. HUNTER pr p,. ..Commission'No. , o y P�- Commission N�•�STELIANotar u State'o1 Florida • �- Notar M NUNTERcommission *1 FF 180552'tic
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I" „F f s"••' xp res an 2$. 2019 P°••'' MY Comm:. on # FF 1805$2 .
Revised OWW2011Bonded MumNatlanalNotaryAssn. � � b BondedthM.- E)fp res Jah 23,
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REVIEWS. FRONT.. ZONING. SUPERVISOR PLANS. VEGETATION SEA -TURTLE. - MA GROVE
COUNTER .REVIEW REVIEW - REVIEW'- REVIEW REVIEW REVIEW .
DATE
LEE 1