HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
DtL` Permit Number: i�QC)
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Building Permit Applicati®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 v/
PERMIT APPLICATION FOR: Building
PROPCSED'hMPR.OVE,NfENT CCtCATlON ;
Address: I C e r .__ F-L
�` to
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No
Project Name:
Setbacks Front Back:_1&4:�Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:'
- ._'®`�--'�-�� -� ( r.� �y'""' .-DDS
CONST ,°UCTIC►N INFORMATfON
Additio,Aal work to epertormed under tispermit–check all tbal appy:
' AC Gas Tank FIGas Piping _Shutters Windows Doors
Electric U Plumbing OSprinklers F–]Generator F] Roof
Total Sq. Ft of Construction: 17-0 S . Ft. of First Floor:
Cost of Construction:$ 100 Utilities: F_Sewer a Septic Building Height:
01NNER/LESSEE: tc mac; "- ( CONTRACT-OR
Name L' L G Name:
Address: a 7 �1 I�d— L� L=t.11� Company: AUG. -e�S, G
City:_l-�f i C f C_-P State: -FL— Address:
,'•;y�j � Fax: Cit � � d
Zip Code:
City:a.P)-L�P) -e_ Stater
Phone No. 1-166 �`j Zip Code:Jq9s I Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: cr�
from the Owner listed above) State or County License: a A Ll S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR.UCTION11E`N LAW INFORMATION
DE59C5NER/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.
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_Signature of Owner/Lessee/Agent Sign ture of Contractor/ tcen e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -::%V L,,sc,*— COUNTY OF
The forgoing instru nt was acknowledged before me The forgoing instrument was acknowledged before me
this day of' J ' 20 Eby this qday of � % 20 t4 by
It
YP
(Name of person acknowledging :" B`%•• SABRINABU7LER (Name of person acknowledging}��` :••`B�L SABRINABU7tER
* * MY COMMISSION#FF 074898 MY COMMISSION ii FF 074.898
EXPIRES:December 8,2017 EXPIRES:December 8,2017
�r��FOFFId���! BonWDruBudgetNoNryServices �j"'FOFFIo� 8ondedThruBudget Notary SDrvices
tgnature of Notary Public-State of Florida ) Signature of Notary Public-Stat of Florida )
Personally Known�OR Produced Identification Personally Know OR Produced Identification
Type of Identification Produced Type of Identific�ion Produced
FI c� Commission No.J , ® O I Seal
Commission No. 8 (Seal) (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS