HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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BU'ilding 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, rclick arrow at the end of line
PROPOSED PR,OVENIEN LOCATI Nr f s tiyt�c�� . , ,, �A r 3,4 , r
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Property Tax ID#: t5-go- no I q - 0G0` �5_ Lot No.
Site Plan Name: Block No.
Project Name:_a _t)U N A-) c.-V%Com.v,-)
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HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator g Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �� >�l-� Utilities:[]Sewer Septic Building Height:
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Name,,- _ _ ^ 1 eta -` Name:: 'c ,y,E,c —�i
Addres 1 c Company:-T4.-CO 0G i^ate ti C
city QrS L4) 6-e-- State:lia- Address: %3A_%
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Zip Code:3 4 CI �3 Fax: City: U0, kDL -c-.c fr,_ State:_ --
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Phone No. ?v2 7,5,1• 0, `� ZipCode:3Sq I D-- Fax: 5.41 's5 -•�fU
E-Mail: Phone No. 5-bI- ccs°ss- 4-1 o 5-
Fill
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Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: �i �� tea 3 t•
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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S,Ut�PLEM l�T�ALrCflNSTRUCTI4N LIEN LAWiNFO MATICIN t � � ` >
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MDESIGN ER/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 Counter makes no representation that is granting a permit will authorize the permit holder, to build the subject'structure
which is in conflict with any applicabWHdime Owners-,}association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Name 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
cminnencing work or recording our Notice of Commencement.
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5` Lure of Owne J Lessee/Agent igna re Contractor [cense Holder
S TE OF FLORIDA STATE OF FLOR A (�
UNTY OF �"�lt'i,6n COUNTY OF. binn o'c/ -
The forging instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of {l obe~ 20 Eby this Jday of.- 20 by
(Name of person acknowledging) (Name of person acknowledging)
/ _
(Srgnatut-e of NofaGyPuYlicFlorida) (Signature o otary ublic-State of Florida)
Personally Known OR Produced identification Persona y Known ,Z0R Produced Identification
Type of Identification Produced Type of Identification Produced
�^ """" ASHLEY FRECH TV
Commission No.C� yob �w'tY�EW1) mJrnis ion No. "Y t, NOEL�bS@ �9N0
° „-s Notary Public-State f on a ,
•„° : •=My Comm. Expires Ja 28,2017 ='t s�°z MY COMMISSION#EE988835
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EXPIR ES APM 12-1-20 10
Bonded Through National Notary Assn. "'
Revised 07/15/2014 y tao7)sse-ats3 Ro0dallotWServ1w.c0m
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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