HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / t�/�
Date: Permit Number: '[ c2 1ZX
911 S>.
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: Window/door
PROPOSED IIVIPROVEME-NT.`LOCATION
Address: ��) CC{-�-h Pc'Ir)a
Legal Description: 1. LoTt ofSS1,-,k55' d3Y3-hG
Property Tax ID#: J 7t)l ' d 1 0009 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: N dJ Right Side:_—Left Side:
DETAILED DES;CRfPTION "OF 1NOR1<..
V;r��B bxl"�-r 1Ad/'J-9 nAJs 70 f-L, ote- /0
CONSTRUCTIQN;INFOR,MATIQN:
Additional work to be pertormed un er t ispermit-check all tbat,4ply:
HVAC Gas Tank ❑Gas Piping Shutters KWindows/Doors
❑Electric ❑ Plumbing Sprinklers 1-1 Generator 0 Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: 0_Sewer E Septic Building Height:
0111/NER%LESSEE,: CONTRACTOR:
Name vN a Name:
Address: la% QLAPaf) C� .ec1no 0 + Company: L
City: F &ere-e State::DL Address:V� �A C /
Zip Code:,J!g9J Fax: City: -�O- tT e -e State: L
Phone No,,!�!t y 7Y 3 Zip Code: y q.�,_I/ Fax: -2—V- � - &7_1
76�
E-Mail: Phone No. 7)A: 6 - 07/3
Fill in fee simple Title Holder on next page ( if different E-Mail:J I u Ok C'1)
from the Owner listed above) State or County Lioense:a& 05b_1 lz,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
:SU'PO LEME`NTAL CONSTRUCTION LIEN LAW INFORMATION
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 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_.Wcording your Notice of Commencement.
s_
_Signature of Owner/Lessee/Agent Signature o Contrac r License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF `Z- COUNTY OF f'' L_ .e
The for�.ving instrument was acknowledged before me The forging instrument was acknowledged before me
this day of -g���ti 20 IG by this 2 day of 120 by
i
(Name of person acknowl edgingk'.PUB'c SABRINABUTLER (Name of person acknowledging) roe `::;'8�.� SABRINABUTLER
.
r '• * MY COMMISSION#FF 074898 * * MY COMMISSION#FF 074896
* EXPIRES;December 8,2017 EXPIRES:December 8,2017
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BondedThruBudgeftta Services Nr°rFocF•���0! BondedThruBudget NotiryServkes
9rE0F FL
(Signature of Notary,Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally KnownOR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type
Type of Identification Produced
Commission Nor !� ["I (Seal) Commission NoR (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS I;;