HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLR INFO MU
T BE-COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Cn Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 D-6-3Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRQ,PQSEl3 I'MPR01/EMENIl"L®CATI'QN: gill
Address: 0511 6!sceo1a _Dr -�4 `lA'eree Fl- 3060d-
Legal Description:4# So(-'orrA el (o J"K L19L li65'3497-JaSS�
PropertyTaxlD#: 3�109 -�'01 �DO l3 —Odo—'l Lot No.
Site Plan Name: Block No.
*Project Name: lew.% I►"( S vie GCL
4etbacks Front Sa' " Back: q` Right Side: V 0d" LeftSide: /,01
D'Et�A�IIED DES�RIPTI'ON ® 1N®R�K: _ - .
sl(A ij,4^ 3oaolb eone�rlll tj.��. f,'ber
�et ?�'K lG` wtav+u�'e�.cro�ec� ��e�- �>>'Z� Q�p�ov��. av►cG,ar-S . ..
CONST 11CTl®N INFOR�MfATI®(V;:
Additional work toe e orme under tispermit—c ec a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric ❑_Plumbing Sprinklers Generator Roof
0
Total Sq. Ft of Construction:s � D S t{. Shed lae of First Floor:
Cost of Construction:$ a�430D.od Utilities:�$ewer Septic Building Height:
Lffi4R R%LESSEE _ C®NTRACT® .n
Name M618. el cne a Name:
Address: X911 /9 5 C e o(a r Company:
City: ¢R e r c Stater Address:
Zip Code: 4 Fax: #7 --g61-84 9 City: State:
Phone No. 19-5729ee-46S 1 Zip Code: Fax:
E-Mail: S� �v�eedc Lei Sa u+L , ✓I E-E Phone No.
Fill in feesimple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or C my License:
If value of construction is$2500 or more,a RECORDED Notice of Comm cement is required.
S'IJPPLEIVIENTL CONR,l1Cfl®N LIEN LAUII lNF0;R11JIATI®N ;R
DESIGN RJENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: '
Name:
Address•_, Address:
City: ' State: City: State:
Zip: Phone: a6JJD7`_539—tr 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 work or recording our Notice of Commencement.
s
ign resof=flwrrer� a/Agent Signature of Contractor/License Holder
STATE OF FLORIDA / ` STATE OF FLORIDA
COUNTY OF L C� COUNTY OF
The fning instrument was acknowledge�btSfore me The forgoing instrument was acknowledged before me
this day of 0 by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of NotkJ Public-State of Florida) (Signature of Notary Public-State of Florida)
Personallyr j$ a,n AN r i ation Personally Known OR Produced Identification
Type of". catigtatgFpt�i�l 1 Type of Identification Produced
' .•; Commission#FF 234730 (Seal)
Commis My Comm.Ex �.P�May 27, E Commission No.
' Bonded through National Notary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS