HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date:f'� �a Permit Number: I60
Building Permit Applicata®n
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
" ROPOSED:IMPROVEMENT LOCATION
Address: S Ovt A__ C14`
Legal Description: 6 6 3 L4 3 Cl I-A 4 C) /h ey 4
4!g L 2_2t 43 1 C L-07L// `
Property Tax ID#: '_ -0OCJ— Lot No. _
Site Plan Name: M a-il f2- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED;DESCRIP.TION_OF.WORK
CONSTRUCTION INFORMATION:
A itiona work toe nertormed under tis permit-check all appy:
®HVAC Gas Tank []Gas Piping _Shutters _ Q Windows/Doors
Electric F�Plumbing ❑Sprinklers D Generator E] Roof
Total Sq..Ft of.Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities.. Sewer�Septic Building Height:
QW N ERAESSEE: CONTRACTOR:
Name - J- Name: c.-" iL,9 il C
Address: Company: /4r 'L-
City: Prrl -F(, v State:E(_,, Address: ,Ef� I-
Zip Code:'3 '1l-/ Fax: ���' City: Pf iM'C-e' State:
Fc-
Phoneko. Zip Code:5 L('?C- Fax: 7 `��� g7
E-Mail: Phone No.
Fill in fee simple Tidle Holder on next page(if different E-Mail:
from the Owner listed above) State or Coun License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPP EMENT�I� CONSTRUCTION LIEIU:LAUid I�IFCDF1NIATi.ON
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY-- Not Applicable
Name: Name:
Address: Address:
Cid: State: City: State:
Zip: Phone: Zip: Phone:
FEE SiMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: ; : Name:
Address: Address:
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 Lucre County Amendments.
The following building permit applications are exempt from undergoing a full concurrency redrew:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
DARNING 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
comroerWing work or recording ou Notice-of Commencement.--?
Is
_Signature of Owner/Lessee/Agentrgnawre o Contractor/License:H0 er
STATE OF FLORIDA STATE OF FLORIOA�
COUNTY OF. COUNTY OF U
The oing instru ,ent was cknowledged b ore me The f ping instru ent was acknowledgeg 60fore me.
this day of. �, 20 this ay o€ ,2C) a�c rsy
(Name of person acknowledging) {Name of person acknowledging)
(Signature of No Pu 'c State of Florida) (Signature of Nota Public to of Florida)
Personal R Produced Identification Personally Know OR Produced Identification
Type of a Millin Pro uc� z,. Type of IdentrFi ork,Ro p
iEt�
! ro *`"' Notary Fublla-"Stately `?:t R AL4��y Notary ANGELA M HUFF "k ��'
Commi e + •= C n � 1pa Commission bio. Y RUb!!e'%. `q'tyof Florida
FF oinmisslon�r
f -;. o,.• 2 4730 FF 2347
g Y Comm,Expires May 27;2019 �'• a�.aP��'��` Y A,kkExpires May��30._
gnrrr �rbmrrN Comm.mEX
� �+9
Revised 07/1512014 �Assn ,,. NotaryAssn
REViEWS FRONT ZONING SUPERVISOR PLANS `VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
iNiTiALS