HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB rpFO T MPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I
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 IMPROcUEMiENT/LOCATION:
Address: Ll �L� &A/Z_h DIY 1!!e CQ( %1 !(/6f aQ= P/Ed2 C �
Legal Description: T� —T 9�4
Property Tax ID#: i 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE�1"�A ILEDIDa^�SCR�'P•�TIO,NILQL' ',".OR+.; _.
CONSTRllC ION INFORMATION:
Additional work to be Deifo-rmed under this permit—check all appy:
HVAC Gas Tank Gas Piping _Shutters Windows Doors 100
Electric ❑ Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
^i
Cost of Construction:$ ��'V utilities: _Sewer Septic Building Height:
NER/LE-�SSEE: CONTRACT®R:
Name_ �, h �`�I�C` Name:
Address: J°q l st 116f bkn) 0_6d'i� �QrM� Company:
city: px2e,F - State: Address:
Zip Code: 24ic�49 Fax: City: State:
Phone No. 1) -9 .J� Zip Code: Fax:
E-Mail: P A P-A73'QAac rrl(44i Z Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: 111100,
from the Owner listed above) State or Co ty License:
If value of construction is$2500 or more,a RECORDED Notice of Comm cement is required.
�SUP�EME'N1`ALCO,NSTRUt;TION�tEN I.AW INF'®RM�ATI®N> { p
X- r. �� r . . any: .. �, . . r....._ .. . .Y. gi p ,.. . .
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 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.
C� s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY
COUNTY OF � ,(
The fgTQing instru ent was acknowledged�efore me The forgoing instrument was acknowledged before me
this ay of 20 by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
,t-",6 L,e,��liiilllll�J/)A
(Signature of Notary P lic-State of Florida) (Signature of Notary Public-State of Florida)
Per nall K own R Produced Identification Personally Known OR Produced Identification
n i ro uce Type of Identification Produced
.dna A,, NCEt* FffY
��lrpv PV9
Notary Public-State/Cof,,F,,�QQrlda
Commissi r3 • mmission#FF 10 Commission No. (Seal)
My Comm:Expires May 27,2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS