HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: �f/��1 Permit Number: 1 ��
•
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 LOCATION: n
Address: 3M Live
Legal Description: �,ra/t /r�y too c-"/.v�h ( � 9 10-31�� 4 , 3, Z�/
Property Tax ID#:3��5 7�7��O�L/-��'�j Lot No._�
Site Plan Name: _ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
co
N,$TRUCTION INFORMATION:
, r
Additional work toe nertormed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing U Sprinklers F Generator Roof
Total Sq. Ft of Construction: 101y7 Sq.Ft.of First Floor: �O � 71
Cost of Construction:$ ��� Utilities:USewer E]Septic Building Height: \
OWNER/LESSEE: CONTRACTOR:
Name Amm Name: &J'e-
Address: 301J Fve rfv,, fir•. Company:
City: State:_L—/ Address: INW .�W .
Zip Code: Fax: City: State:
Phone No. Zip Code: ��9�y Fax:
E-Mail: Phone No. 7 ,7
Fill in fee simple Title Holder on next page(if different E-Mail: TZ �, 2 0;yla.//,cavi
from the Owner listed above) State or County License: BGG/ 3DGS3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
e .
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.
12s
_Signature of er/Lessee#4ent Signature of Contra icense Hol
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _T&1;7�4 COUNTY OF
The forgoing instrum nt was cknowledged before me The forgoing instrum nt was knowledged before me
this
/�Z day of c- 20 Llby this 3e) day of CSC 20 1Jf by
Jp6P��rd✓I-�� I�d�/�'� �rydl/f f'
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
\` q11N1111llllll�i ��1111111111111/lll
Personally Known > OR Produc*�\\ lt�a �n �� � Personally Known OR Produced Ide a
Type of Identification Produced .��O;•gS10N fXa'••. �� Type of Identification Produced0do
N Ek'•.• ����
Lo
Zr N21201&'
Commission No. _ :#Al)�•� ¢_ Commission No. •� i
si` qFF 122434 y.%o s AFF 1224 y
�i��i3O>.•.�d n,omN`;:�p�C\��� iiO�•••Bud9ptNolaN;::p��\�
Revised 07/15/2014 ,i/uouc,i����`�`\� /q%�tlauc.������`��•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS