HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 `� �tp ' Permit Number:
4
RECEIVE®
Permit Application
Planning and Development Services Building JAN 2 7 216
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 c/
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: �Z�cl C.,Ai-0s gi Ie/C
Legal Qescription: j�rt 1J J . eolrCsS� j�S L[�LJG 07 - g LI(-
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Property Tax ID#:iiilq 2 —,60 9 -G q7S—Q00 '( Lot No.
Site Plan Name: Block No.
Project Name: TvV LtW LV old— c� S
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION , FWORK
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CONSTRUCTION INFORMATION
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Additional work to be Pertormed under this permit check all appy:
HVAC . ., - Gas Tank E]Gas Piping Shutters Windows/Doors
®Electric ❑ Plumbing Sprinklers l Generator Roof
Total Sq.,Ft 6fConstruction: S Ft. of First Floor:
Cost of Construction:$ G�dm C'C7 Utilities: —Sewer Septic Building Height:
OWNER/LESS,EE. CONTRACTOR.
Pow.Name �/�� �S`- Name: Ir'CoQ�c2i Pw.
Address: Z4 ey p4,Qr ZR (Yid lr;V6 Company: E(J�LCV- f=L,�c¢o.L
City: AL-LSTI Ai State:�X Address: ZS-G'
Zip Code: S7� @� Fax: 722-��--2�9L/O City: -5 L�GG y State:%-L
Phone No. `7 -72 - (-5,2h —7_0`l o Zip Code: t/risZ Fax:
E-Mail: .M022icez , , JN00"0 c2.Mr41L- e0/1-c Phone No. Z 7 --,53 `-�-// T 7
Fill in fee simple Title Holder on next page (if different E-Mail: �JC16--6-L,148rz1/- 1a .,c-1.6
from the Owner listed above) State or County License: ZG1:300 127
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 COMPANY: Not Applicable N
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'additibns,
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 th first inspection. If ou intend to obtain financing, consult with lender or n attorney before
comme in Work or rec n our Notice of Commencement.
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STA E OF FLORIDA : STATE OF FLORID
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COUNTY OF '¢a- ` �' COUNTY OF
The forgoing ins um nt was acknowledged before rp. The forgoing ins men t was acknowledged bef egmes`
this- day of201In by z Dr this day of 20/6 b 3 X�a
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(Name of person acknowledging) o;$ (Name of person acknowledging)
Vim` • � � �N � i��
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(Signature of No, a y Public-State of Flori a) (Signature of Notary blic=State o Florida
Personally Known OR`'Pduced Ide tification—/ Personally Known C(R Pro vced Ide tificatiori
Type of Identification Produced- Type of Identification Produced MA
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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