HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED e�
Date: Permit Number:
RECEIVED JUN 14 2017
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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 ���O�a�' %d.y%�
PROPOSED IMPROVEMENT LOCATION:, -
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Legal Description: Stc1,4, 3S, %ti/h ?zS )&,"
Property Tax ID #: 35_3,�_- 601- ODa,-- ^ DOD - 2 Lot No.
Site Plan Name: Block No.
Project Name: xSf4ac� t)tw-e5 (Q06 .<<46rw,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION.:
Additional work to e e orme under
11HVAC Ei Gas Tank
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Gas Piping
apply:
Shutters F]
Windows/Doors
Electric
14-1
Plumbing
Sprinklers
Generator
1:1
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 00
S Ft. of First Floor: _
Utilities: LJSewerOSeptic
Building Height:
bWN ER/LESSEE:
CONTRACTOR:
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Address: g��a s Dc��� (fir Apl 633
Name:
J�tiKµ1Y ate,
Company:
Address:
City:
Zip Code:
Phone No.
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City: State: FL
Zip Code: Fax:
Phone No. �J_ S�� 9�% -rZc�/��
E-Mail: /a4-
Fill in fees mi pie Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
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State or County License: A, d Is- r
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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S:UPPLEMENTA'L CONSTRUCTION LI,E'N LAUV INF`O.RMATION
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 Co mencement must be recorded and posted on the jobsite
before the first inspection. If you intend to o in financing, consult with lender or an attorney before
commencing work or recording vour Notid; of Commencement. /?
Signature of
ctor/LWensefKolder
STATE OF FLORIDA 1/STATE OF FLORIDA
COUNTY OF 4. Luca , COUNTY OF Sq G'ruw
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this jT day of 20 Irl by this _I _ day of T7uwi, 20 14" by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida ) /
Personally Known OR Produced Identification ✓/
Type of Identification Produced(
`��4pgY PUB�i/ice J
Commission No. ° Commission i FF
My Commission
June 12, 2
Revised 07/15/2014 `1 4t)q> 3Q
(Signature of Notary Public- State of Florida )
15637
18
Known X OR Produced Identification
ntification Produced
n No.
MY COMMISSION 0 FF9UM
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
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INITIALS