HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MU BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��f/ 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
PROPOSED IMPROVEMENT LOCATION:
Address: 7 i) o-g
Legal Description: 5 `r, 'T
Property Tax ID#: 37;-5 703 0/30--000 o? Lot I4.o:
Site Plan Name: BI&V No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�IacQ wo k f y0 gal e 1_e0+p4'C (_)jQ- z',� h2Q-�-o-
�;��o�
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit-check all fl apply:
HVAC Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
U Electric Plumbing Sprinklers [i Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 760 Utilities: F]Sewer E Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name CO Name: 9� ,
Address: i . 6 uo / _ Company: Gl f l � G
U
City: V1 State: -FL- Address: II ,,nn^^ 11 Q O � {�
Zip Code: 1 Fax: �^ City: �e SMA g State: 7��-
Phone No.7� J 337- � 2&9, Zip Code: 6 Fax:
E-Mail: Phone No. =- 00/0
Fill in fee simple Title Holder on next page(if different E-Mail: - -N C. )0k
from the Owner listed above) State or County License: G 12 q ogq
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 thepermit 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 wo ecording your Notice of Commencement.
- s
_Signature of Ow r/Lesset�'
Signature of Contractor/License der
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF 3t- Z'(ey"=e COUNTY OF -77- e�e f,.,6e- -
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this //day of V41 20 ZM this R day of \;�?,ze__ 20 /J'by
Q)`? 63 -6gP?OV
(Name of person acknowledgin (Name of per on acknowledging)
(Signatur of Notary ublic-State of Florid (Signature of No ry Public-State of FI Aida
Personally Known OR Produced Identification Personally Known OR Pr duced Identification +'
Type of Identification Pro Type of Identificati Produce to—D
~ �,� ,. OPI2:67020�°�+ n Nptpry fpblic,State of Florida fi Notary PubliN ida
Commission No. o `��`"�. Commission No. :
om issiomx FF 167526 COmmissl
My comm.expires Oct.9,2018 My comm.expires OC18
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS