HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST 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,.IM,ROVEMENT.LOCATION a
Address: lY) i C7
^� — ��
✓\�
Legal Description: /�C� � [I"��� �C i.�r�/� � C�.
Property Tax ID#: 31-1 L/ 7-0&,20 Lot No.
Site Plan Name:Sic.rn /:::7^ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEl' LED DESCRIPTION,OE WORK.
fI J -�,�-C Oma.-, /� ' /.zCO� �7�i�'� S A e- /L
10,e 9/—X fq4
CONSTRUCTION'INFORMATION
Additional work to fl
orme un er t is permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof CJ "
Total Sq. Ft of Construction: 4� S .Ft.of First Floor:
Cost of Construction:$ l 4® Utilities: Ll Sewer Septic Building Height:
OWNER%LESSEE ;CONTRACTOR.
Name r6fm "k, Name:
Address: 'tD r r Company:
City: C.- State: ALO- Address:')-, m.� S.� y✓�t r�,�'
Zip.Code 3445_c_A--, Fax: City: 10< State jaA
Phone No. X7 X Zip Code: _,3 4/! 53 Fax72-,�, 2
E-Mail: _� Phone No. -T.1,_ 72 G (;-C>911--
Fill in fee simple Title Holder on next page(if different E-Mail: r2.lLi3 f-2-
from
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 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
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -:5' Lug COUNTY OF
The forgoing instrument was a knowledged before me The forgoing instrument was acknowledged before me
thisl day of 20 Cby this �-I day of 20 by
Jc -
,�7 A l L= ��
(Name of person acknowledging) (Name of person acknowledging)'
.zUL4-0,-
14--P--
(Signaturve of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally KnownOR Produced Identification Personally Known 50 OR Produced Identification
Type of Identificati n Produced "` Type of Identification Produced
r /� r
Commission No. � II 1 A egeal KIRK ARI K mm Sion Nor"
.r..,(.... c ) mea
`•. My UUIy?MiSSIC�N ifF 044924 to 1" h Klif;: ARI KATZ
EXPIRFSAiq st12 2017 t ! MYCQiv'.id"+t,:910N#FF0449
(407)398-015J FloricltUlutnrySorvicacom Z�c*xofs'
9SEXPI11=;
Atiqust 12,2017
Revised 07/15/2014
11c,;k:yaikauvyScn[ice.com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
rI
OMPLETE
ITIALS