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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: / 3 Permit Number: • 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: Address: C Legal Description: Property Tax ID#: �' Q �' (> Lot No. Site Plan Name:— Block No. Project Name: QJaA,,Q Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: '*4, r.4 �,Lo�d �� 4/,��'C./ G�-c��Ce.t'• \`,1 ,(`1®��w�e��� Com+► �� CONSTRUCTION INFORMATION: Additional work toe nertormed under tispermit—check all appy: HVAC Gas Tank ❑Gas Piping Shutters Windows DoorsIV P g ❑Windows/ kN Doors Plumbing ❑Sprinklers I Generator Roof Total Sq. Ft of Construction: p S Ft. of First Floor: Cost of Construction:$ 8 406. p0 UtilitiesInSewer Septic Building Height: OWNER/LESSEE: CONTRACTOR: Nam, � G� . .. e: ' Address�o c �.�CzG r Company: Agi;k al, State:L Address-R42! 46- k4;ve. k� Zip CoderZ',n'7 Fax: J!VO-0 SSA City:-,�. !f-AaAA.0 , State Phone No. 77A - D- fflc?f Zip Code: OV9#5 Fax: �(i/.q7?S E-Mail:/Qet.�11�i/104C CA@Q;A�atLA , ©np Phone No. &F.1 77�? -9;7&0 G$g5/ Fill in fee simple Title Holder on next page(if different E-Mail:&&F. - Pf. 71 C'.�L• C OIr1 from the Owner listed above) State or County License: 4eid— M40-5EST Al. If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMP Y: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLPER: _Not Applicable BONDING C1pJMPANY: Not Applicable Name: Name: IV 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 inspectio If you intend to obtain financing, consult with lender or an attorney before commencing work or re o ing your Notice of Comm enceme t. y s Silikature of Owner/L ssee/Agent Si re of Contrac /License Holder STATE OF FLORID STATE OF FLORIDA COUNTY OF COUNTY OF Lx.CC�p P� The forgoing instr. m nt was a knowledge fore me The for oing instru ent was acknowledged before me this day of ¢.� 20 Vby this day of i U�Yh 20.4�,y (Name of�erson acknowledging) (Name of person acknowledging) — (Sign ure of tary Public-Stat of Florida (Signatur of N taa_ryPublic-St to of Florida) Personally Known OR Pro d(c*v'owndo �� Personally Known ::/� OR Produced Identification Type of Identificationut.ProType of Identification Produced Commission No. �(Seal) Commission No. eL FNus2g20��e� • * Ey,P�P Ne�a9 Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS