HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application -i
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 INIPROVEMENT.tOCAT10N
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Address: / i''�
Legal Description: VIP gt� 301 ucF b t-Kxt tt\nip 13 1 ZO or
1131103 C�2 t9lLt1 " f'lC16
Property Tax ID#: B o` ~ (' 0(4 — o a.—,X6 R 0001
CS 1 Lot No.
Site Plan Name: J6
Block No.
Project Name: 9absr t C&A T6,Pi2seity
Setbacks Front Back: Right Side: Left Side:.
® DETAILED DESCRIPTION OF WORK"' CIA
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CONSTRUCTION INFORIUTATION
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Additional work to be nertormed urider t ispermit—check'a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers E Generator ❑_I' Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 7 r L Utilities: Sewer[]Septic (Building Height:
OWNER/LESSEE �..,".. =CONTRACTOR � ...., s' �
Name � Name: i ff
Address: Y
Com an ��iACeb t . -r WdL 1
Company:
City:FA i'p re Q State: Address: (' K 'vt `k
Zip Code: ® Fax: City: �{�- i � State:,
Phone No. "�� �� �t� Zip Code: i Fax:
E-Mail:� M��i u�0 �\��q� .� Phone No. 7 ,�►',
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:�'
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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St�PPLEMENI"AL CN l.iN LAW INF AT
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DESIGNER/ENGINEER. . Not Applicable MORTGAGE COMPANY: j. �Not Applicable
Name: Name:
Address: Address:
City: State: City: ( State:
Zip: Phone: Zip: Phone: �1 /
e FEE SIMPLE TITLE HOLDS : Not Applicable • BONDING COMPANY: j =Not Applicable
Name: aA vv%"So 6 Name:
Address: . 3 - c d �c kqq Address: I
City: t City: r
Zip: Pho e: -1-70.-IM ,il Zip: Phone: 1
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 thepermit 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 respect's;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 anofther 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 recording our Notice of Commencement.
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_Signature of Owne Lessee/Agent Sign ure of Contractor/Licensd.'Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged efore me The for oing.instrument was acknowledgeJd pefore me
this�day of �a ,G& 20 ltl by this V'day of_ ��L ,20 �by
L h el Ser/ow 0?;01 X-le,I S C rM C41—
(Name of person acknowledging) (Name of person acknowledging,)
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(Signature of Notary P,bl'c- ioOX' 011
ublicat-State of Florida) (Signureof Notary Puublic- tate of Florida
vPersonally Known OR Produced identification Personally Known �roduced Identification
Type of Identification Produced Type of Identification Produced,
Commission No, (Seal mmission No. V (Seal)
DARLENE HEISERM
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Revised 07/15/2014 ;,F EXPIRES:JUN 05,2017 , =o: Y'.°i� MY COMMISSIONPF0244S7
* F Bonded through 1stState Insurance EXPIRES:JUN 05,2017
h� Bonded thropoh 1st 8 to Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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