HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: lSl" �' �J� Permit Number: /�U to .
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Building Permit Application DECEIVE®p'
Planning and Development Services JUS ®.Z 2015
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
PROPOSED`IM"hPROVEMENT`LOCATION.r -- ,.
Address:
Legal Description:
Property Tax ID#: C)_CCL( Lo -C zo - 2C Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK . "
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ADD a 01�Nt,Y 1-169TS tn1 fllPrs i6k
CONSTRUCTIO..Na INFORMATION, r a w
Additional work to be nertormed
. under this permit-c ec a11 appy:
❑HVAC Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
�lectric Plumbing Sprinklers _Generator
1:1 Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ �tU Utilities: _Sewer E]Septic Building Height:
OWNER/LESSEE:. CON1"RACTOR: '
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Name Name: F\eP V(-li Q_
Address: \2 � �� � 1�CSLC���� Company:
City�C"\fM , State� Address: C-Aki"z)�,
Zip Code:Sy(0I Fax: City. _C& Q__ State:�-
Phone No m ` _ � Zip Code: _ i CjS2 Fax:
E-Mail:Y \ �\L�N-C&, CUN" Phone No.')_)* --J C)1-1
Fill in fee simple Tit Holder on next page(if different E-Mail:C C_yV-Ckf v-\4-.\@ CAN
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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SUPPLEMENTAL CONSTRwUCTI,ON LIEN L4VV INFORMATION a
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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,cons It with le er or an attorney before
commencing work or recording our Notice of Commencemen .
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_Signature of Owner/Lessee/Agent / Sigriature of Co tractor/Licennse Holder
STATE OF FLORIDA 1, STATE OF FLORIDA
COUNTY OF I Lai, COUNTY OF XI
The f4in,instrum i was acknowledged efore me The forgoing instrument was acknowledged before me
thisday of 20 by this__,2Zday of 201 by
oil&\ f �m�
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(Na f pe son acknowledgin (Name of erson ackn ledging)
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(Signature of Notary lic-State of Flo a_) � (Signature of Notary Public-S to of Flo\�go
Personally Known V OR Produced IderQ Personally Known OR Produd Idly ® Cr
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) q, �'p�` mmission No. V"�*_
�l 1� s18192
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'1i�,,iC STAUEOF�e\°\\
Revised 07/15/2014 �d1111#11111M,%k
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS