HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �(/ 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 lin a
PROPOSED IMPROVEMENT LOCATION:
Address: IQ S3 Ae
Legal Description: ,el?O V &4,5 7 /0
Property Tax ID#: e-li ®2 i3b/ 12616 ,,7000 Z Lot No.
Site Plan Name: �/7�.J`7��� /sG►G L'1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
/e, r P0%' /c° i'Zi L -3 000 P5, E/ (tet/l2elh&P4
Z � 6 ® �l� oh
CONSTRUCTION INFORMATION:
i ional work to benertormed under this permit-check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities:i Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR: f
Name ✓� �- � e-,— Name: mak" GGUl6
Address: 1` company: 6a Th les. 14IF
�
City: c ,d State: ' Address:�I � /lr'�+.L��L eli
Zip Code: Fax: City: -sStater
Phone No. Z 63 Zip Code: C/GL'c�� Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
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 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
comr)@en,pingwok or recordjpg Vour Notice of Commencement
r
gnature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIWD j ()
STATE OF FLORIDA
COUNTY OFA COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this�_L day of -2i_15by this day of 2014 by
(rc J�(Name of erson acknow edging) Name of person acknowledging)
(Signature of Notary7011
State of FI rida) (Signature of Notary Public-S ate of orida)
Personally Known Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. DAW tl� E Commission No. (Seal)
' e��,' NotaryPublic-State of Florida
'��► u _ Notary Public-State of Florida
Revised 07/1 - `oaoc CommiU0111111.r. 'FP.R WIF 92 9n17 UAI.A.101 PC-now
ssion .EE 877571 l
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Bonded Through National Notary Assn. y
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onded Through Na Tonal Notary Assn.
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DATE
COMPLETE
INITIALS