HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -63S6
Date: ^ �� 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
PRC�FOSED IMPROVEMENT LOCATION
Address: '
5 1
Legal Description:
Property Tax ID#: t`12C)- `q l- C)M 1- nC-)(_)- C) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
4 .
DETAILED: DESG'RIPTLON OF WORK # `' {'
&A/�a.
CONST R,U,CTION INFORM 4TIONr
Additional work to be performed under this permit–check all apply: _
HVAC Gas Tank ❑Gas Piping. Shutters Windows/Doors
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Electric 0 Plumbing OSprinklers ElGenerator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$
�� Utilities:[]Sewer[]Septic Building Height:
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OWNER%LESSEE CC+ TRACTOR..` m`
Name Name:
Address: zy' f1i Company: r
City: In ilnn State:J1 Address l Zip Code:Code: –I Fax: City: ` I'���/( � State:1' l
PhoneNo. �S�-'l°Jl'1 Zip Code: Vax: _
E-Mail: Phone N
Fill in fee simple Title Holder on next page(if different E-Mail.. - -
from the Owner listed above) State or County License:Ccl I LWS
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 work or recording our Notice of Commencement.
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_Sign � S
re of Owner/Lessee/Agent ig�wr o�Cntr�,ctr/U�cese older
STATE OFLORIDA STATE OF FLORID!�
COUNTY OF S 1 ,t 0 C IJ- COUNTY OF < 'SC SZ �C QST-
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The for mg instrment was acknowledggd efore me The4TrM
gokng instru ent was acknowledged before me
this day o 20by thiay of 20 by
(Name of person acknowledging) (Name of person acknowledging)
E)(_tom a— M1 A' -Z 2)Lec&
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Pro du d Type of Identification Produced
%, flREf 11t1MTf11EZ ' CE "'. %. ' BRENDA MARTINEZ
Commission No. a ` '.T. -Stadia of Fbrltls ommission No. �� `'e�dtary Public-Stitt of FI a
• Commission#FF 231585 :• •3 commission#FF 2315
,r31 901101s
''••°;�� Fiorsied Nttloral Assn. '��M�.•�, 19
MMO �y '' BMW though tfgtional Notary
Revised 07/15/20 14
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS