HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Glx fin.�. 2,c�c�P�� 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 arrow at the end of line
PROPOSE=D IMPROVEMENT LOCATION r
Address: l i�w� Q r a (c G_U i j"�rZT )oC,,c-c!c-,
Legal'Description:Q4 s'r P' P"'arce, 05G-rn-a -cA Rpc!Qrdeop 10tn-'n g-mr- S9, �q S
Property Tax ID#: a-3r7Q�7o��n.�, aoo Lot No.
Site Plan Name: C� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION „
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Additional work to be pertormed un er t is permit-checR all thatapply:
HVAC Gas Tank Haas Piping _Shutters Windows/Doors
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Electric Plumbing Sprinklers EGenerator �oof
Total Sq. Ft of Construction: S c)oc> S . Ft. of First Floor:
Cost of Construction: $ 00Utilities:
Septic Building Height:
OWNER/LESSEE CON
TRACTOR:,
Name L,i, 'ror -P �_ sr- Name: �C0c LA.v.,6it-,
Address-a, Si L)4ng►ro, ( CA,2�-¢__ Company:�l6 v--
City: : ` -��L�o Stater) Address: q(Ry C
Zip Code:,31 -,Li Fax: City: _7r",01;2 Pc e State: J
Phone No. c3 ma c'?I-,( 7> / Zip Code:�%YQS< Fax:7 7 2- 4&2
E-Mail: Phone No. ?Z Z-- IL-$-0 z /
Fill in fee simple Title Holder on next page( if different E-Mail: t �U,u.00. �ov�`��`��f�c� C��✓C,
from the Owner listed above) State or County License:JZC ao tai 7.V?
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL_GONSTRUCTION LIEN,LAW INFORMATION.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Ad d ress:
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
commencing work or recording our Notice of Commencement.
s
Sign ure of Owner/Lessee/Agent Signa re of Contractor/License Holder
STATE OF FLORIDA CU STATE OF FLORIP4/
COUNTY OF ' COUNTY OF
The f r oing instr�m`ent was acknowledged for r�2 P The forgoing inst.ument was acknowledged be f a rte,
this Q day of l 20�J by i-- ¢ L. this /i day of _lOi- 20 ^�
BE: �LL y
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(N me of person acknowledging) = !� /(N me of person acknowledging} ?as F
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(Signature ootary Pubfic-State of Florida (Signature o otary Public-State of FI•rida } Rr
Personally Known�/ OR Produced Identification Personally Known `� OR Produced Identi ` .
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS