HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �J _ � Permit Number: �"
5
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)4624578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
-PROPOSED tR1PR011'�MENT I.QCATION
Address 2-q kk& an-ea �C�S4
Legal Description:
Property Tax ID#:Oq L/- Sol-/-701- O)d-q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIP`!'tON OF 1NORK
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CONSTRUCTION INFORNIATft?N
Additional workto jeve orme under this permit-check a appy:
0HVAC i__f Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric Plumbing Sprinklers 0 Generator Roof
Total Sq.Ft of Construction: SQ.-Ft.of First Floor:
Cost of Construction:$ '7n1 / �" Utilities: _Sewer F]Septic Building Height:
OWNER LESSEE, :: ... . ,. CONTR ►CTOR
Name Y Name l!e Y GZ
Address• 61
! Y' Q� Company: e, a� a
City: aY� _&('&� State: Address: i'
Zip Code:J(/q5 . Fax: City: / e- State: J•Z—
Phone No.�"770,&[ -Sq&� Zip Code: H� _ Fa/x•�������
E-Mail: Phone No. l 6-"�a6L
Fill in fee simple Title holder on next page(if different E-Mail-
from the Owner listed above) State oounty se:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5upht ENTAL.CONSl"RUCTt01 Lj:EN LAVA INt=O,R�111X1 J.,
.. . _ :.r. .... _ .. : ..::..
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:
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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 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
commencing work or recordipg your Notice of Commencement.
Signature of owner/Agent/Lessee ignature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF Q/ COUNTY OF
The oing instrunee/nnt�w�as acknowled ed before me The fo oing instru ent was acknowlet� ed before me
this-NEday of_� .2 by this3f day of y
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(Name of peLs�n. g�bwli dg :o_ (Name of person acknowle� :v Q�ati � o_
(Si nature of px,anr*p c- `a Florida) (Signature of N ;Ku_ Si �4TIAW
NOT
Personally Known v OR Produced Identification Personally Known >/ OR Produced Identification
Type of lden"nti i a ion Produced Type of Identification Produced
Commission No. ,PFn 7vz Sg (Seal) Commission No.FoorVa-W (Seal)
Revised 07/15/2014
REVIEWS. FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED