HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE'°INFO MUST BE COMPLETED,FOR APPLICATION TO BE ACCEPTED
Date: t�%� Permit Number: .-- 03
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-2553 Fax: (772)462-1578 CornmerCiDI Residential d`
PERMIT APPLICATION FOR: To Select from dropbox,-click arrow at the end of line
PRO,PQ5�D Ir1�llPRQUE1VlE`iIT LOCA° IwQN "}x_t,;e,. Y. .r. ' ,£ `._ _ x y
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Legal Description:
Property Tax ID#: J S Lot No..
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDESCRIPTION;OF 1hZQRK 4 F
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CONSTRUCTION INFORMATION
�fAdditional`work to -e ne torm under this permit-check-all appy:
PM[ZHVAC LJ Cas lank ❑Gas Piping _Shutters Windows/Doors
Electric M Plumbing ❑.Sprinklers F Generator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ H L03 Utilities,: Sewer F Septic Building Fleight:
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Q:WN ER/hLESSEI ..rte .-
Name C.b4k L.,IPPI o '.
Name:
Address: -� �� Company
City: ' _ 15 State: /r- Address
Zip Code:`3`f a' Fax: City- State:
Phone.No-. -7-0 Z,Z. 4 3Za Zip.Code: Fax G"
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E-Mail: �G E!"I(-, i2�G �� Phone.Na,-.
Fill ia fee sithole7itle Holder on next page(if different E-Maikos
from the Owner listed above) State.,or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required_
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SU, ENIENTaL CONSTRUCTION'LILNLA\IV
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DESIGNER/ENGINEER: NotAplicable --� ' y (Not
t A_pp:>lic�a'.b.�l.eVORTGAGE CO
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:
Lcertify that no work or installation has commenced prior to the_issuance ofa 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 wor recording our Notice of Commencement.
s
—Signature of Owner/Lessee/Agent Sigrature of Contractor cerise Holder
STATE OF FLORI STATE OF FLO I
COUNTYOF �P �� COUNTYOF Mr-hn
The forgoing instru ent was acknowledg d,.hefore me The for ing instrument was;acknowledged before me
this;�day of 20� by this Z.�ay of QQ 20 a b
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F C,!-f Momcm
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary blic- tate of Florid ) '(Signatu're f Notary Publi -State of Florida)
Personally Known OR.Produced.lden N Personally Known x OR Produced Iden
Type of Identification Produced--D Type of Identification ProducedT����� ASHG
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Commission No_ _q16 obey s�0y;'o�� Commission No. e/ V p al pctobejss��?u�
sod ac�.rn __a• g'G.O�
may• � o�;Z .21• 0 NTi'��
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Revised 07/15/2014 �: o� 9m
- B•�6��Ulhru � �� it �:;/ny °.< ;~':_
REVIEWS FRONT ZONING �8j� EW OR PLANS VEGETATION SEA TURTLE 'MANGROVE
COUNTER REVIEW- REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
CO NI P.LETE
INITIALS