HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �aCi�I S� Permit Number:
RECEF3 JUN 2.91015
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
P'ROP®SED I �PROUEMENT LOCATIt3N:
Address: y�S I CO 5v (x3S�'� [,
Legal Description:
Property Tax ID#: J na �2 O O OOH d0 �� Lot No. r
Site Plan Name: Block No.�
Project Name:
Setbacks Front Back: Right Side: Left Side:
D A1LED D"ESC; IPTIO O Vk/®RM: _
p. i3
CQNSTRUCTION INFORMP►TIUN:
Additional work to be nertormed under tispermit—checka appy:
HVAC , Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ ( l c( Utilities: _Sewer 0 Septict ,Building Height:
O�WN�ER/LESSEE: CONI�RAC�tTOJR:
Name M64 g i \P,, E464 L0 Name: > - �✓. : I�' -
Address: �4S<It, . �`: QL✓ _ Company: lAt' `c �GrvG t'►� "�
Cit) State:State: Address: lCY'' CT
Zip Coder Fax: city: T P�CR-Lt State
Phone No. fid'`ZO 1�,(0 {. - Zip Code: Fax: 7?69- ? 9 -0_3
2
E-Mail: Phone No. 17,x? T-S-40
Fill in fee simple Title Holder on next page(if different E-Mail: N<'�. k tArJ `�C2� \ t9 y1oL. Cc,
from the Owner listed above) State or County License: ZW609 �
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'S.11'PPLEIVI!OR CO.NS�1'R,L1}}1, ION '!LIEN LAUV I,NIF®RMATfON:
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. Ifyou intend to obtain financing, consult with lender or an attorney before
commencing work or reco ng your Notice of Commencement. j
s
_Signature 6f Own a /Agent Signature of Contract / ' nse H I er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF d��� COUNTY OF
The for oing instru ent was acknowledged ore me The for g instru ent was acknowledged before me
this ay of 20 y this ay of 20 1. by
ri�1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary u blic-State of Florida) (Signature of Notary lic-State of Florida)
Personall Known OR Prod dentification Personally Known OR Produc d Id tification
Type of I y r duced Type of Id ' a 'on Produced 1
A(VGELA ' �= Seal)
Commis Q MHMea Comrra'�Po J• ANGc�.:_
'• • �if ��-State of Flotlda Cc luillrY Ppppc HUFF
m S
A, Co mission Ar FF 2 �' f ago;°� mrt►!ss tate of F
ing—
Revised b7/15/2014- ,. ft:ev77.20f9 ',����", B�edtlyougx���n�aY27730
2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS