HomeMy WebLinkAboutBuilding Permit Application ALL APPLIIC' LEI FOC MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J J Permit Number:
•__ a Building Permit Application RECEIVED
Planning and Development Services MAY 15 1015
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 C�
PR PPOSED IMPR®1lEM�NT l®CATI® : ,,[ /f
Address: /� / 1 v,C,. r9��9�1� �� O2 c< Y, Z_e,, /( J V Y�3
Legal Description: Lao z 2 i�� .D1a ck_ 39 6,r rt/e s2 [,
Property Tax ID#: 3 C� I ( �O 6 2 o S 00 C) Lot No.
Site Plan Name: Block No.
Project Name: F C�
Setbacks Front Back: Right Side: Left Side:
DETAfLr�D ��E�5�CR�1!P`f 10`N O'F 1l'1�0`i�IC:
rn1 C2. Quo 0-9 Sd M+` , S f c o pf• 0 ge i
CONST UCTI4'N INFORM/�T(tJN:
Additional work to be nertormed under tispermit—check all, appy: El
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers "Generator Roof
Total Sq. Ft of Construction: -Sq. Ft.of First Floor:
Cost of Construction:$ /S00, Utilities: Sewer Septic Building Height:
CIWNER/LE�SzSEE: CONTRACTOR:
Name ( - Name: OW NM fCbc�(
Address: 11 ? ME-; Company:
City: q)?>L StateFL Address:
Zip Code: 3 4 3 Fax: City: State:
Phone No. 3 oS c4 3 2 — 7 L/63 Zip Code: Fax:
E-Mail: -:S-,4y C m Lki Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU'PPLEIViENTAI C®NSTRUC,1"ION TEN Ll�W IN ®,RCUTATION�
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
commenqqg work or recording our Notice of Commencement.
s
_ n to of •4vn�er/ essee e t Signature of Contractor/License Holder
TM; *�`
ST OF FLORI _ � r STATE OF FLORIDA
CO TY OF ice' = o• COUNTY OF
The forgoing instrument was acknowledged before a m�a The forgoing instrument was acknowledged before me
this f S day of // 20/ by this day of 20 by
/
p-) &)QIP-QC-1 w g
(�a'meo�person acknowledging) ' A (Name of person acknowledging)
(Signature 011),otary Public-State of Florida) V (Signature of Notary Public-State of Florida)
Personally Known OR-Produced Identification Personally Known OR Produced Identification
Type of Identification Produce _ A & • 0122i` Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS