HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED qq
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
PRCMPQSED 4,
"OibcA 14ri'
Address: 2–
Legal Description: .4ogg /9 z-,>t x-g-- 1'6,1 .19-21— 0,57C—
Property Tax lD#:- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
.DETAILED- SCRIPTI
ON WOR
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CONSTRUCTION INF IkMgIO�K'
Additional work tobe nertormecl uncler this permit–check alilIttla apply:
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HVAC [3 Gas Tank Gas Piping 1_ ShuttPrs Lu Windows/Doors
11 Electric L9 Plumbing RSprinklers El Generator ORoof
Total Sq.Ft of Construction: Sq.Ft.of First Floor: I
Cost of Construction:$ /"Q Utilities:0—Sewer n Septic IBuilding Height:
LESSEE =
--TOR.
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Name Name:
Address: . d.2_ Company: 7`4e
City: State: 1144 Address: ?�
Zip Code: a 2
Fax: City: Ac( State:r-6-
Phone No. C17 Zip Code: ? Fax:
E-Mail: Phone No. ?�2-33G 7272
Fill in fee simple Title Holder on next page if different E-Mail:
from the Owner listed above) State or County License: IY2!�r-YI19
f value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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St1,PPLEMENTAL CONSTRUCTION LiEN LAIN iNORNIATiON
DESiGNERANGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone: Zip: Phone: !i
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: I Not Applicable
Name: Name:
Address: Address:
City: City: I
Zip: Phone: Zip: Phone: i
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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 Amendme!ts.
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
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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.
_Signature of Owner/Lessee/Agent Signature of Contracto ce der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFr� `�-- COUNTY OFhL��-+
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The for ping instriMerlt was acknowledged before me The forgoing instrument was acknowledged before me
this Zday of_ 20 j-by this day of f h4,1 _I 20 #,,._by
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(Name of person ackno eaging U (Name of person ackno -edginga JV 0, -�,P/1 4�L--
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(Signatu of Notary Public-S t lorida) (Signature of eta ublic-Stat of Flon a)
Personally Know O rodracec Id} 'facatioPersonally Known OR Produced identification �-
Type of Identific ioGtiyced o Type of Identific tips g c
I CYNTHIA J DAY
tary Publi -Stale of Florida ftt t P
Commission No. Comm.>S �Jul 9,2016 CpmmISSIOn NO.' _ �1, r5`Public f 81)af Florida
* : My Comm. Expires Jul 9,2036
�orFOFF Commission# EE 215118 jCommissian y EE 235318
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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