HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO M ST BE_COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 iNIFR`OIIEMENThLOCATI'ON , ..._ f . ._ '.� , rl,r. ..`4
Address: �IQtU,S-19-0 I :clq6 _ >.
Legal Description:A f'i �Ly j d u./ Ad/ of^Z
Property Tax ID#: cc)c�,,�rboo! Lot No. ZZ)
Site Plan Name: Block No.
Project Name:_ /??we10 AD
Setbacks Front )0I Back: 6 Right Side: Ii
g �_Left Side:
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a t
CNSTICT)ONml !gwEm
R,itiona worto c ec aappy.
HVAC ng Shutters Q Windows/Doors -
�Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ ['j�Q_ Utilities: Sewer 1 Septic Building Height:
OWNERJLESSEE �� CONTRACTOR
Name /c/z` C,� ` Name :
"g(z/
Address: l Z`f f�IaPSC +�!� Company: �-
City: LPJAHo/0 f'f r M5 State:gH Address: 2� �cq) (ZOAP-T"
Zip Code: TY(� Fax: City: /✓,S State: ec,
Phone No. q'FO— 'Yv9 -cR 7 Zip Code:�3,�_< Fax: 27
E-Mail: Phone No. 7bZ7
Fill in fee simple Title Holder on next page(if different E-Mail: Ch i,3 f2,ei 24 4,V(2&1*0
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CUNSTRUCTIONLaEN LAW fNFORMAT101� f �
z a a �f tee,
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 1 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.
Sig ture.of Owner/Agent/Lessee Signat f of Contractor/License Holder
STATE OF FLORIDAC%'OLS/2 STATE OF FLORIDA
c
COUNTY OF COUNTY OF
The fgr�'ng ins ent was acknowledge before me The fo nstr n�acknowledge�l�efore me
this`'��""� ay of t'L�(i 20 _by this day of 20_L0 by
(Name of persona nbwledging) (Name of pers4ackndging)
- Z_��
(Signature of Notary blic-State of Florida,) (Signature of NotaryP li/c-State of Florida)
i Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced _ Type of Identification Produced
Commis o p` KATE StaIL GAT
teoEPhi ) Commissi no. K.®NTES(Seal)
Commission A FF 17588 r, rotary Public,State of Florida
MI,PFIFRM AV
My comm.expires July 17,2017
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
[INITIALS