HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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: /Z®$ 1AA' &rS Gr�-lC I
Legal Description: 14&.r6oJ r- K4'41.e_ P 1&,t 14� ���` �s- /o Se,..1 f l y�e V t1�1cc�l f C.�t' S
Property Tax ID#: qq 23 70 oo-oi Doo { Lot No. S
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION`O.FWORK:
r,•,o�c. 3 (Z-e lac,-� e - ✓J�s f�oo.�, P�a c.-�
-CONSTRUCTION INFORMATION!,
Adclitional work toffGasTank
Orme under this permit-ca appy.
HVAC ❑Gas Piping _Shutters Windows/Doors
11 Electric E]PlumbingSprinklers E Generator F] Roof
Total-Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ -t ZJ� d� Utilities:cnSewer 1:1 Septic Building Height:
OWNER/LESSEE. CONTRACTOR
Name �2/'� Leiwl� tea✓ Name:.., C.;rfi-S v r1
Address:/Zc3'e NW Company: c-DRveLLS5 CLQ
City: a.l G!�^I State:F(., Address:3 2-51 Da r�i^'i c,-,Ie-(Y'
Zip Code:3q qcf U Fax: City: $ficJoV-f State: �L
Phone No. q/Ui 6 Zy 'F6/'7 Zip Code: '3�Ao,ctrl Fax:'1'17-7'6( Z5706
E-Mail: Phone No.l`12r'Z( 5- g q4
Fill in fee simple Title Halder on next page(if different E-Mail: M('60U ofp 9 M1o✓q-L.. 1Le4-
from the Owner listed above) State or County License:Z 3`'(,.3
c.-&C- 5,v
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL:CONSTRUCTION Ll€N LAW aN,FORMATION
DESIGNER/ENGINEER: Not Applicable' MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE,SIMPLE TITLE HOLDER: _ of Applicable BONDING COMPANY: 4Not Applicable
�;Nam`e: 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,recordin our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1N*^Tiw COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
K
thislZ day of r*A. A4!f! 20 Eby thislday of�,x;CY.1iL�a/C 20/F* by
Cwm*4 TWA&V
(Name of person acknowledging) (Name,of person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florid pOgT/T
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��\1\ e • \t,MISSIp�,•.��f' V�
Personally Known x OR Produc`§���tiYf�Ya �F,• ��i Personally Known q. OR Producecitie� i �8 ,o'•
Type of Identification Produced ��Q�.• �1%•_ Type of Identification Produced :�4•
Commission No.deI0 if 7810 J§ea% �� by°rn� Commission NoFFlr 73O @a1)/FF 157861 Q
biAl
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS