HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
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
PROPOSED IMPROVEMENT LOCATION:. ,
Address: IC115 VC-1 Ica Q-11M Cf. . I � �
Property Tax ID #: �"[" �9� od- ouss OLY ) Lot No.
Site Plan Name: AcmQodc, Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRI'PTIONOF WG.RK:
Y �- a,r, �� •, e
C�:F5
CONSTRUCTION INFORMATION:
Additional work to be pefitormed un er Miping
it — check: a apply:
11HVAC _ Gas Tank _ Shutters ❑ Windows/Doors
11 Electric ElPlumbing -Sprinklers FIGenerator EiRoof Roof pitch
Total Sq. Ft of Construction: S . Ftofof First Floor:
Cost of Construction: $ CX7 Utilities: Sewer []Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Z
Name: '��)Y '<-4- io,(( ls. u
Address: `
1
Company:1
City: State: Pi
�p
Addre s: 'l � i \I S V-d
Zip Code: Fax:
_
City: l�� State:
Phone No.
Zip Code: �1-I�� cal Fax:
E-Mail:
Phone No. I L ' t-��� "' ay--)
E-Mail: (AI' l G&)C& CQY
Fill in fee simple Title Holder on next page ( if different
State or County License: y114
from the Owner listed above)
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
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
commepGing work or recording vour Notice of Commencement.
Signature of
as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instr ent, a acknowledg efore me
this day of 20 by
(L�v 4-1 (�In IC) a�C;Ici
(Namur person acknowledging
re of Notary Pwblic- State 6f. Florida
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. ,y pu �e of Frorida
+F Antonia Pau'(a
v • M I Commission FF 191201
^"121,07o
Revised 07/15/2
The Today
ing instrument w s acknowledg fore me
this of 20 a by
(Name of $e� on acknowledging)
j I
(Signature of NotaryFtatiliC- State of FI
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.—p�arypubliast�t�®t�lklb�raa
d�. Antonia M Paula
• .... r.,mmission FIR 191201
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS