HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r/�c c
Date ,� Permit Number:[JV b ✓0gii
bit � 7
0
•_
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 IMPROVEMENT LOCATION
Address: "Icrr L:Ezl�nK—_
Legal Description: _Jc�! 3 1 Q rhr/i'l
h
Properly x ID#: Lot No.
Site Plan Name: //24 o try 4 Block No.3_
Project Name:
p Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O�WORK_
CONSTRUCTION INFORMATION =
s
Additional wor toe e orme under t is permit-check a appy:
HVAC F Gas Tank ❑Gas Piping _Shutters IJ,Windows/Doors
11 Electric F]Plumbing OSprinklers Generator Roof
Total Sq.Ft of Construction: / 136 S .Ft.of First Floor: moi/
Cost of Construction:$ to o6 Utilities:n Sewer Septic Building Height: U
OWNER%LESSEE CONTRACTOR
Name hfiv, kxlName: C¢ P-ft_- clz
Address: q zd Company: / r z
City: revue State:�L Address: ff fl�
Zip Code: L(g5 ( Fax: /� City: Ffi !CPr State:: Ff,
Phone No. '2227 -35-7 Zip Code:J3 L67 U ) Fax: 7 7"_1"760i`�`!�!
E-Mail: 4J a- Phone No. 7 C-f 1�/".'3 t 19
Fill in fee simple Title Holder on next page(if different E-Mail: ceP- UecU ced
from the Owner listed above) State or Coun License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
"/� ILI
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORML�TION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:b _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 Commenceme .
G� s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID � , _ �J STATE OF FLORID y
COUNTY OF— _ , COUNTYOF
a
The for o' g instr pent was acknowledgedhefore me The fo g instru nt was acknowledged before me.
this ayyof 26/)—by this c day of 201_,S:b1i
v
( ame of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public t4 of Florida) (Signature of Notary Publ' -State of orida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Y�NI'_uNE I Commission No. (Seal)
Commission No. y= "Y a o, Notary ubhc-State of Florida 9
• My Comm.Expires Mar 2?.2017 "" r
commission •.P AWN MILONE
°;;�� � Bonded Through National Notary Assn.I /•� 4`,A Notary Public-State of'Florida`
Revised 07/15/2 14 f� �
,•_\ =/Q My Comm.Expires Mar 22,'201
�; E 877571
.1 B01140Jbintinh 1 a• .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA �I�ROV
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW R
DATE
COMPLETE
INITIALS