HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: Permit Number: 1 S '
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 OCATION :.
Address:
Legal Description:
Property Tax ID#: ;�K40 3Z-60-7-01 "f 000-? Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks -Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
l
CONSTRUCTION INFORMATION.
Additional work toMG
orme under this permit-check a t a appy:
❑HVAC s Tank ❑Gas Piping _Shutters Q Windows/Doors
❑Electric LJ Plumbing ❑Sprinklers ❑Generator ❑Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �(),�(� Utilities: Sewer I Septic Building Height:
OWN ER/LESSEE; CONTRACTOR:,:
Name Name: I i
Address: ,5 v ie- Company:
City: Stater{. Address: ,
7 61941A
Zip Code:,5__ — Fax:
City: Statello-
-49
Phone No. Zip Code: r Fax 17o?'W44-5)
E-Mail: Phone No. 7
Fill in fee simple Title Holder on next page(if different E-Mail OV-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 CONSTRU N 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 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 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
commepqing work or recording your Notice of Commencement.
S
_Signatur of Owner/Lessee/Ae
t ignatur of Contractor/Lice Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF '• � _ COUNTY OF 91 .L(A�Ci�•L
The f r oing instrument was acknowledged bore me The forgoing instrument was acknowledged bpre me
thiMday of 20 [,�,_by this Z day of,9,6V\ 20 L12_by
r �
r ICP e Q l2 !cQG
(Name o rson acknowledging) q(Namf person acknowledging)'rSf
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at a of Notary Pu c- tate of Florida) lgnature of Notary c-State of Flo d
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced ape of Identification Produce
��"Y'F''' LIBERTY A KING
•., ------
LIBERTY I ING ' ' �` SeGI MISSION#EE 877248
Commission NotiM
MY COMMISSIONfg�pG�is n No. ' .: := ( M
a EXPIRES:May 4 2017 pp EXPIRES:May 4,2017
Bonded Thru Nolery Pu ic�Underedters "'•;p-��;.0••` Bonded Thru Notary Public Underwriters
.,Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS