HomeMy WebLinkAboutBuilding Permit Application (2) i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: C uFJ `lJ'Yly
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
NO, LOCATION F 'f `
Address: SFO o
Legal Description:
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Property Tax ID#: L 5=S t -- G.L S Lot No. I`3
Site Plan Name: Block No.
Project Name: 1� ✓gym ��nom-.
Setbacks Front Back: Right Side: Left Side:
QE �AIIED DESC131PTION'OFWORK F � `
Q L
;:i-... 2,. : w.s_,.. r » ... -L ., .f.F .w .., esem..e, �.-: i�...! :.;-.t xr.,,: .-t r'. .t..J F..,•� i•<<`_'._�- ,f„�e�
it�ona wor to e e orme un er t is permit-c eck aMrS
py: L
HVAC Gas Tank Gas Piping _ utters FlWindows/Doors
Electric 0 ---
um ing ❑Sprinklers Generator Roof
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Total Sq. Ft of Construction: 1 G(dCD Sq. Ft.of First Floor: �'Io O
Cost of Construction:$ -2--4c) Utilities: Sewer El Septic
- :Building Height:
C)WNER/LESSEE f 7 CONTRACTOR 3
Name-'d-d S-e- J Name: �-
Address: D Company:�t' =-(Z- ICflvt� Wc �. rte(
City:,--- State./- Address: C6W i� ,�_�
Zip Code: Fax: City: ��-- •�-- it ��'+S3 State:k-,�
Phone No. 2- �' - Zip Code: 51,"S3 Fax: �'17_NaQ&-k-
E-Mail: Phone No.'r12 33 Cg -
Fill in fee simple Title Holder on next page(if different E-Mail: 12+rn ►'�.�«,ie G��/1 , t
from the Owner listed above) State or County License: 'lr-137a(�1'l2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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kN i PPLEMENTAL C T1f NSTRUCTIONLIEN"LAW={INS
QRMATION
I z, .. =s ,_. .. MORTGAGE COMPANY: :-
DESIGNER/ENGINEER: Not Applicable � Not Applicable
Name: Name:
Address: Address: f
City: State: City: I State:
Zip: Phone: Zip: !Phone:0
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: ✓I lot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone: J
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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 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 respects ,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lude 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
commencinR work or recording our Notice of Commencement.
s
Signature of Owner/Lessee/Agent Signature of Contra r/License Holder
STATE OF FLORIDA STATE OF FLORIDA—
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was atknowledged before me
this day of 20 _by this�day of� L�7' .20/by
l L/e-
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Nota ub ic-State of Florida)
Personally Known OR Produced Identification Personally KnowdW
u O 'R�Iification r
Type of Identification Produced Type of Identifica ''n dweZ.
O��IISSl41 FF tAAti36 -
Commission No. (Seal) Commission No. EX,,1AES:F b;iiary-iy3'20a Y,`
F'�FFCa- a00dPdThr�BUdgelNata �RrR � _
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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