HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONt.4
ALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^t
Date:PermitNumber:
=RECEIVEDBuilding Permit ApplicationPlanning and Development Services Building and Code Regulation Division2300 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 too}
PROPOSED IMPROVEMENT LOCATION:
Address:
R
PL 3%i519Z SCANNED
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Legal Description:
Property Tax ID #: _'3` qbp ,y - 1 2, C)c> I V ' c*O " S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks, Front Z'St Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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N'INFORMATION:
IJHVAC L==[ Gas Tank UGas Piping LJ Shutters
11 Electric 0 Plumbing Sprinklers 0 Generator
Total Sq. Ft of Construction:
Cost of Construction: $ Z500,00
S Ft. of First Floor: _
Utilities:nSewer 0Septic
Windows/Doors
0 Roof = Roof pitch
Building Height:
OW N ERAESSEE:
CONTRACTOR:
Name ¢rv.'e )U f
Name: M�,(wc e1-W,6v-
Address.-( "6 04re,5 {iVr�
Company: Qtjdr&4.s A4-ee &4r44v45 -C.
Rr !1 ercc State: Ft-
City: n
Zip Code': 3'f 9 8L Fax:
PhoneNo.
Address:.2loc 5�0 6ve., ,f- he
City: PSL- State:Ft-
Zip Code: 3(fIS3 Fax:-?Z-$11'ed09
Phone No. % - 670'z.3SO
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: cddcc �4 FY„ cv% �oo.Ccvk
state or County License: C'. BC O r-i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 111
Address: tj h
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cbnflict 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
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Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORID!
COUNTYOF FLORID
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The for oing mstru ent was ckl
this/a� day of
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(Name of person acknowledging)
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STATE OF FLORI
COUNTY OF Z vG r O 40(A
The forgoing instrument was jpc-knowledged b2fore me
thisayof Pin/ .20)�Zrby
person
of IVotary Public-
fr011 111 )111\W,
Personally Known _ OR Produced Identiticatlion Personally Known OR
Type of Identification Produced Type of Identifica o adGucel
Commission No. god (Seal) Commission o 0
Revised 07/15/2014
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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COMPLETE
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INITIALS