HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 'y1 CJ 1 l�J"CJW
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 IMPROVEMEN-3,0CATION L
r .
Address: �v ;�Ul _ ,..
Legal Description:
Property Tax ID#:_ /} gO d 6 S--" C?f 2i !CLQ O Lot No.
Site Plan Name: Block No.
Project Name: -7�>^
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
'C0NSTRUG"fION;INFQRMATION.
Additionalworkto a e"orme under this permit—check a appy:
HVAC 0 Gas Tank , ❑Gas,Piping _Shutters Q Windows/Doors
ectric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities: 11 Sewer E]Septic Building Height:
OWNER/ ESSEE•.` CONTRACTOR
NameName:
s GCS Company: /! r1 -i P'
Stater-- Addres
Zipode:- n- j:;. r, City: i, Stater .
Phone No. Zip Code: V-0 Fax: L6 071'7(6-7
E-Mail: Phone No. Z3 ILTI*
Fill in fee simple Title Holder on next page(if different E-Mail: /Al �v n�� n� S�r/I •`�"'
from the Owner listed above) State or County License: �,7 Q5-7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL`CONSTRUCTION LIEN LAW INFORIViATION
DESIGNER/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 1 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 w"th Tender or an attorney before
commencing work or recording our Notice of Commencement.
a . � 6 s
_Signature of Owner/Lessee/Agent Signature of Contractor/License old(,e_r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 _by this G01\1'61 day of 20 by
1 I
(Name of person acknowledging.), (Name of person acknowledging)
(Signature of Notary Public-State of Florida) 4( i9a1t:u:re of Notary Public-State a Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced 0. X17
Commission No. (Seal) Commission No. alq .�"�P`e(, (SOU"L.TOMASZEWSKI I
IMotaq►li-State o1 Flori
• 111frAW, C0IAalfttbn I FF 218f34
MY :Expires Apr 12,20
Revised 07/15/2014
' "'•��, WedthrauO National Notary Ass i
,Q
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS