HomeMy WebLinkAboutBuilding Permit Application ALL APPLIIqAB4E INFP MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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: ICS
PROPOSED IMRR'OUEMENT L iOeCATION x
Address. � 1
US �s
Legal Description:
Property Tax ID#: `T LJ _ 51 - oci)b1 - oco- `+ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
jDETAILED DESCR'IPTIONtO`F WORK
,.
`CON-STRU`CTION INFORM ►TION:
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Additional wor to a er orme under this permit-check a appy:
HVAC E] Gas Tank 0Gas Piping _Shutters Windows/Doors
MElectric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
C'ID
Cost of Construction:$ Utilities. _Sewer ElSeptic Building Height:
OWNE LESSEE tl wx 3 CONTRACTOR 8`
Name ' ( Name: CL—
Address: `-t SEis Company:
City. 1Lv G State: Add res 1.CD}C '1-� ��
Zip Coder-�l,O rZf- i Fax: ` City: 'Stfate:�( , ��-
Phone No. - �c�p�p- �J��1 Zip Coder7�-C ��2- (( Fax—`'t —q(`"t(a`.>
E-Mail: Phone No. -4-U -'S3
Fill in fee simple Title Holder on next page(if different E-Mail: Q Qb _ COTY)
from the Owner listed above) State or County License:FCV"- Wk s
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTALCONSTRU t'TION LIEtN,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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_Sig >t e of Owner/Lessee/Agent Sig t e of Contractor/License Holder
COUNTY OF ORIDA -1 Q �c l� COUNTY OF STATE OF FLORIDA �uCJc
The forgoing' instr ment was cknowledged before me The forgoing instrument was acknowledged before me
thi20`Sby th[SW day of 20 115by
3'_am_� L�Q�. — NQL��_ -
(Name of person acknowledging) (Name of person acknowledging)
VIQZ
(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
p4;Rv � A MARTINEZ
` 41-ta..
BRENDA MARTINEZ C Z �J a 4'`'y�e� ary Public-State of FI a
Commission N41 1�3S. �bry Public-State of Flo I�ao mission N _ Commission#►FF 2315
Commission#F FF 2315 5Explfe ��� My Comm.Expires May 31, 19
BondedthremmoughNatl"Nota yftsn. altafy BdMed bough Nailtmall NNsn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS