HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / ✓ i
Date: �D !' Permit Number:
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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: __ -e
Legal Desc ' io
1 l
Property Tax ID#: + 'r Lot No.
90/1
3101Site Plan Name: �r ���% S ( � , Block No.
Project Name:
Setbacks Front Back: L7 Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Rx's S A b 41 -,- rA yr ?Div
2z 30
CONSTRUCTION INFORMATION:
Aciditional work to be nertormedunder tis permit-check a appy:
HVAC L_I Gas Tank ❑Gas Piping Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:.$ Utilities .• Sewer Ej Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name i l- Ll$ e-1? Name: CA-0- C "Ale
Address: AnGO X z 1(9 Company: � Z &6 w d?
City:gV d T-Lf h d (rll lr State: � Address:
Zip Code: 33 rl Fax: City: Jrt,�vL°/-I State: J
Phone No_ �zRI �l �L�� Zip Code: 21v� Fax:
E-Mail: Phone No. -7D l 4X961
Fill in fee simple Title Holder on next page(if different E-Mail: y�t�
from the Owner listed above) State or County License: l;�d- Maze:ZZ/,q
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 Jhe first inspection. If you intend to obtain financing, consult with lender or an attorney before
comTocing work or recording our Notice of Commencement.
ignature of Owner/Agent lessee Sig ture of Con ractor/License Holder
STATE OF FLORI k STATE OF FLORID
COUNTY OF COUNTY OF ,
The forgoing instru ent was acknowledged before me The for oing instr ent wa acknowledged before me
this day of 20 3 by this 77 day of 20 by
(Name o rson acknowledging) (Name of person acknowledging)
I r�/��
(Signature of Notary Public-State o orida) (Signature of Notary Public-State of Florida)
Personally Known d ti cation Personally Known "�F� n ification
Type of Identificati n, esti DAwti ne . Type of Identi- do �" °°a= D
Notary Public-State of Florida �, M1'COY Public (ate of
MY Comm. rida Commission No. , mm. 1 Florida
Commission No. "� - - esigam Mar 22;
tori n. Commisslo Mar 22
0,o,, o?r Commission#EE 877571 �9rtdsdYA/p R'#EE 877571'
Bonded Through Nati, 110h-
Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS