HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f r
Date: a2 Permit Number: FJ I" Ot
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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
tP513 IIVIP101lEMEIIT L y _10 ^lud"r , >
Address: 52 �W �'
Legal Description: /a ('ILIA Rates RkAI5e- 11 - a- Lo�- 42
Property Tax lD#: l - v��l —�a�� -rJ���� Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme under this permit-c ec a appy:
HVAC Ei Gas Tank Gas Piping _)Shutters windows/Doors El
11 Electric 11 Plumbing Sprinklers a Generator 1-1 Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ �iio< ��' Utilities:'nSewer Septic Building Height:
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Name i ,.;,.Q b�a��'rsayt Name: r�i (,cJis��Lw
Address: S--.00t .�..>'r 't)✓ Company: .
City: r{L PI'vC State:FAddress: t_'
Zip Code: Sgq,5_( Fax: City: ) L, \�r'C'C UL State: t_
Phone No. / v oL� /� - :�y� Zip Code: 3,'?-Cf Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: eau _
from the Owner listed above) State or County License:1��-,G 2=0h90
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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`dS � LEMEN� :G }NSTRUC 'IDN SIE �LAUU IN1= t1�lLATIO'Ii'
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DESIGNER/ENGINEER: V Not Applicable MORTGAGE COMPANY: -v/Not Applicable
Name: Name:
Address: Address:
City: State: City: State,:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: __�/Not Applicable BONDING COMPANY: 2Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
1 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 thepermit 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 reqording your Notice of Commencement.
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_Signatu of , ner/Lessee/Agent Signatureof Contr ctor/Lige Holder
STATE OF FLORIDA , STATE OAF ORIDA ,
COUNTY OF COUNTY OF .5-,dAll (Z-vim
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20 L by
(Name of person acknowledging) (Name of person acknowledging)
A�
(Signature of Notary Public-State of Florida) (Signature of Notary ublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced T@pe of Identification Produced E
LVAN it)RAYMOND P
Commission No. I OTARYPUBLIC Commission No. NOTARY PUBLIC
TATE OF FLORID IDSTATEoFFLOR01
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Expires 111=201V -ftyll- E*res 11261—
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS