HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 here
PRIJIsQSED ENPROVE ANT l.tCA 'I4N
Address: U.
i
Legal Descriptio00d 7 rAdw /2 ,
Cl l P BZ/2_8> (NE 916-10 )
Property Tax ID#:-� r'"iP I Y" 0145.3 — 000s47 Lot No.
Site Plan Name: Block No. 1(03
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTl:ON INFQRIAT�(?N�
Add
ttiona wor to e e Orme un er t is permit—cheCK all that appy:
11HVAC Gas Tank [:]Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers 01 Generator Q Roof
`Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 445' Utilities:11Sewer QSeptic Building Height:
QWNR/LESSEE CQN1'RAGTR s
Name ef-im Cta04- Name
Address: 65d K I.64sCompany:
City: �) Stater.. Address: �.
Zip Code:".l Fax: i7°7�"- {Or9�i�' City: i(k Stater:
Phone No._�'��� `� �j Zip Code: 7— Fax:
E-Mail: Phone No. Ill—`o 5-1
Fill in fee simple Title Holder on next page(if different E-Mail:QI�1�Qt1Qt .Ir{�
from the owner listed above) S ate or Co my License 1916
If value of construction is$2500 or more,a RECORDED Notice of Co�rnmencetXent is required.
SUPPLMN'FA C(?NtUG"1JI�; ' N } AT# ?i r t i it
DESIGNERjENGtNEER: Nat 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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
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 pians,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 recording our Notice of Commencement.
7&Z,
Signature of Own&/Agent/Lessee itignature of Contractor/License Holder
STATE OF FLQRiDA J STATE OF FLORIDA—
COUNTY
LORID
COUNTY OF C �f/l GLI�_,lt.� COUNTY OF `�G: R uLL'I,CJ
The forgoing instru ent was acknowledged before me The fo oing instrument was acknowledged before me
this 13t7 day of 20 by this day ofKdt4 .201M by
(Name of person acknowledg n (Name of person acknowledging)
lillflta
(Signature of Notaryubiic-State ) lir ( gnature of Notary P lic-State of Florida ,`N6 E CAen�'iv
\\\ G rr•w•••• f�/r �` \•ieasr.•:T'� r+/f
Personally Known_�OR.fh ` I� fatR►hitatj Personally Known OR ProducId
Type of Identification Produca, �isr IC, •:�` Type of Identification Produced =
Commission No. Commission No. F474253
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%411!; ST PA
Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED