HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO M ST BE-COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 Permit Number:
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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
,PRO'P.DSED IMP ROVE ME NT.LOCATIOX:
Address: ::fS2 5 l
Legal Description:
Property Tax ID-#: ` 7 C7- 2( d - (MU -- Mb-- I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF
WORK:
S
CONSTRUCTI ON°INFORMATION:
Additional work toa er orme under this permit-check a appy:
HVAC E] Gas Tank E]Gas Piping _Shutters Windows/Doors
14 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ / Utilities:cnSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:, .-
Name 1 Name:
Address: ` CC Company: —
City: �l ,�c� State: Address: V ;
Zip Code: ( 0(,-)(Q(a Fax: City: ` ��� States �'
Phone No._117 - ,Com,- Vim Zip Code: �-L-�g2 Fax��- 4Q#-`--I;(_iss
E-Mail: Phone No. 711- -
Fill in fee simple Title Holder on next page( if different E-Mail: S fflL
from the Owner listed above) State or County License: Vc l L�-�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SURP_LEMENTAL 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
Siat of Owner/Lessee/Agent Sign to of Contractor/License er
STATE O FLORIDASTATE OF FLORIDA
COUNTY OF � 5—L Q CCOUNTY OF c ,\, ucc _
The fAcgoing ins ment was acknowledged before me The f_grgoing instr ment was acknowledged before me
this _ day of 20 Eby this day of 20 15 by
(Name of person acknowledging) (Name of person acknowledging}
Z_' C� &�_(— Its Q�
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known_I—OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Produced
) Type of Identification Produced
Commission No. DIPS i ion No. (Seal)
,,�p `+r � BRENDA MARTI EZ ,,��p+ ����,,,,,�� BRENDA(MARTINEZ
P1 It-Soft
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Revised 07/15/2014 $•i AMComsnbsba#FF 231565 • commission#FF 23158
dd. My Comm.Expim May 31,2019 =9, �,d; My Comm.Expires May 31,2 9
y'''•°;„�P BclldedlhrougrN/fonrrNoWyAssn. �''�%'��t°`'��, Bondedt NadonaiNotary A n.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ISEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS