HomeMy WebLinkAboutBuilding Permit Application ALLIAPPLI lCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 rJ�S C\- y L
® C r ; D SEP 2 9 20b
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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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEIVI.ENT LOCATION. _'
Address: �`JI �� wuprl
Legal Description:
Property Tax ID#: Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
`DETAILED h`DESCRIPT:I,ON OF WORK ;,p
arJ +1
a
t�
COkNS`TRUCTION§INFORMATION:: a
Additionalwork toe e Orme under this permit-check aJ appy:
HVAC E]Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator F] Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ (��� Utilities: Sewer 0 Septic Building Height:
DOWNER
/LESSEE CONTRACTOR . rs''
Name '1 ,S� Name:
Address: - 60 A Company: Irt +U
City: P State: Address: WC
Zip Code: " S1 Fax: City: +T (tyu State:_
Phone No. -177 -U4Lolo -'SZZ1 Zip Code: Fax ? -LVA-
4US
E-Mail: Phone No. - M2�
Fill in fee simple Title Holder on next page(if different E-Mail: �Ey_s rnCAi� !aL nL
from the Owner listed above) State or County License: a 1aLU L�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLENI;E'NTaALCONSTRUCTION LIEN LA1N INFORMATION £ x
SFS` a"- x
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
_Signat=OFF
wner/ Contractor/Licenser/License
Lessee/Agent Sign t e of er
STATERIDA f STATE OF FLORIDA <�4 C��
COUNTY OFCOUNTY OF
The forging instrument as ac cnowleclgecl before me The forging instr ent as acknowledged before me
thI;2`�Jay of , - 20 by this day of V 20 �by
=�� C" �')Cixu� a_4L'L
(Name of person acknowledging) (Name of person acknowledging)
ale_21L LAQz- nk= ob f1_ NZ__
(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
Commission No 1. (Seal) &IOMIVAM Co mission No. �,���.x... .,Sea BRENDA MARTJ31, 019
Notary Public•NO of ' Notary POIC-State.1 Com i1m_&FF231!WS- 00111111110211013&FF 9316
,� .•' My Comm.Expires May 31,2019 jos My Conan:Erpinti MRevised 07/15/2014 ''•��'� "'' BondedtlraiphMtlo�WNo ryAssn. 'ri.%
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS '