HomeMy WebLinkAboutBuilding Permit Application RECEIVED JUN 22
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (A aa'A I 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 d�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:g .I
Address: 1 l �J IV , (�)(dl Dl xic H A/V • �or�T �t�fZGre. F �L. �J�1� ��
Legal Description:
Property Tax ID#: 1 69 �Z!7�( � � d U Lot No.
Site Plan Name: Block No.
Project Name: � tiL
Setbacks Front Z .� Back: �_d Right Side: Left Side: 10
DETAILED DESCRIPTION OF.WORK: ''-
�0 rr H a V\J 1=!s7- 3_ 501�(0��C'-TT��/
L\ ' fi �- 1 S r �, q Propr C Il-lzcr 3 C56tk r P
CONSTRUCTION INFORMATION:
Additional work toe e Orme under t -checkispermit a appy:
1_1HVAC E]Gas Tank ❑Gas Piping. _Shutters Q Windows/Doors
aElectric ElPlumbing OSprinklers 0 Generator F Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ (7(� Utilities Septic 1:1Septic Building Height: 4
OWNER/LESSEE: CONTRACTOR:
Name L•ul�q�_ ;g"D�S Name:
Address:(T_k/, n d ,p IX l JJWY Company:
City: 'K ll`2G15 State:�l� Address:
Zip Code: 39 46 Fax: City: State:
Phone No. 71-7 4 -S 7-5— -ZD 3`� Zip Code: Fax:
E-Mail: ko1 oAG 4oT KAI..J=i czy%n 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
commencing w9f k or reccirdJing your Notice of Commencement.
s
_Sigatur of Owner/Lessee/Agent Signature of Contractor/License Holder
STAT OF FLORIDA STATE OF FLORIDA
COUNTY OF S k. L- a-,\-R,' COUNTY OF
The forgoing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
thi-�a..day of 20 by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi State of Florida) ignature of Notary Public-State of Florida)
PNNp 0\0r, o a
Personal) Known OR Prod entifR�a Sia �6• personally Known OR Produced Identification
Personally p�t\(tft 56�-
Type of Identification Prod c ka1 Fxv�'e �c g58� ��Xpe of Identification Produced
Commission No. �J = *:."ea)romm`SS a r+� ooa� $`r (Seal)
d'3eal th�oo9 :rte' Commission No. Seal
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS