HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: —6�SCD
•
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
PRO;FOSED IIVIPROVEM.ENT LOCATION
Address: 42
Legal Description:
Property Tax ID#: z2— I ZZ-Ccol _Cu`)_ O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
CONSTRU.CTION-INFORIVIATIQN; �
� sF
Additional work to be nertormed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
JAI Electric 0 Plumbing Sprinklers ElGenerator E]Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$c-0 ('1C`l rfl Utilities: Ft
0 Septic Building Height:
OWNER/L'ESSEE :a xCONTRACTOR
Name C Name:
Addre s: Company:
City: u State:n-\l Address:.IOLQ
Zip Code: Fax: City: pleka��,, ���� Stater
Phone No. Zip Code:��49&?_ Fac'IP Ch-of -4
E-Mail: Phone No.z1Z -4 132
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: ED0 S( IcUS
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLE-MENTAL 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.
S
_Signa of Owner/Lessee/Agent Sig a of Contractor/License Holder
STATE OF FLORIDA STAT FLORIDA C L I
COUNTY OF FLORIDA!
�� e_ COUNTY OF
a
The for oing instru ent Was acknowledged before me The forgoing instru ent was acknowledged before me
this ay of 20 Eby thi day of lk 20 L:�_by
G—
(Name of person acknowledging) (Name of person acknowledging
(Pc r)L�
(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 Produced Type of Identification Produced
Commission No. 1 "' ��.,, (Seal) BRENDA MARTI1 Co mission No. ���.,, e
°r°. ;`�•.• Notary Public-State of Flo Ida �v EMDA MAR11( r
Commission N FF 23166 z. Notary Publ�-State of Florida
My Comm.Exp res ma31,:019i IVAy MY Com 5
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Revised 07/15/2014 '��.����� Bonded through NatlonalNotaryAssn. �''•�°n,i���` �� y31,2019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS