HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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
PROPOSED IMPROVEMENT LOCATION.
Address: 1 U�-
Legal Description: E uc n /' �Sff r (J rr� (1�' ,�/ 7
PropertyTaXID##: YQ� - IaLa_ a% Q� Lot No. l
Site Pian Name: Block No. %(
Project name:
Setbacks Front Back: Right Side: Left Side:
[!�ETAILEQ DESCRIPTION of WORK.
q21)
CONSTRUCTION INFORMATION:
nnAac0tional work toje�je Orme un er t s permit - c ec a appy:
LrIHVAC Gas Tank []Gas Piping _ Inshutters Windows/Doors
Electric Plumbing 0Sprinklers ❑ Generator II Roof
Total Sq. rt of Const uction: S Ft. of First Floor:
Cost of Co struction
$J� ) Utilities: _ Sewer �5eptie
Building height: _
OWNER
LESSEE
CONTRACTOR:
Name
Address:
City: 1
Zip Code:
Phone No.
E -Mail:
Fill in fee simple
from the Owner
ao
Name:OfiePhIIj
Fr' a
Company: ►f, lAuntblftaLt's
s State:
y2� Fax:
Address: �Q SI' 'BSI- �
City: Pbrt St, L'46LState: FL_
Zip Code; 'M215 2- Fax;_7
Phone No. T7 2- ? ;? 7 - 3(6 $ ?_
Titl Bolder on next page( if different
listed above)
_
E -Mail; �¢rt2sts�ub Se�rdtc rn
State or County License: Cr 2 Q
w value 01 elinssrucuor is ?Lbuu or more, a KLLURUTA) Notre of Commencement is required.
SUPPLE ENTAD CONSTRUCTION LIEN LAW INFORMATION.
CiESIGNE /ENGIN ER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: hone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: �. hone: ZIP: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Copnty� make 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. P ease consuult with your Home Owners Association and review your deed for any restrictions which may apply.
In consider tion 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 followir g building permit applications are exempt from undergoing a full concurrency review. room additions,
accessorys uctures, 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
improvery eats 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
comment ng work or recording our Notice of Commencement.
s
_ ignature f Owner/ lessee nature of Contractor/License H r
STATE OFFLORIDA, STATE OF FLORIDA
COUNTYF_ _51. L-, ;`, COUNTY OF S'`1 %�• ,'
The forgoin instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ,_Zd y of 26 11 by this 2 2 day of f - 20 e4 by
(Dame son ck gi r (Name ersnn ac d ing
AT Oil -
AN R
4 C 9
Sig3pt
dd.Il e of rida
o) ary I 1 1.
as aiea.earc
Personally Known OR Produced Identification ♦ Personally Known OR Produced identification
Type eativri Produced ype tion Produced
Commission !No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISORPLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
RATE
COMPLETE
INITIALS