HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: 3- a f l`� Permit Number:A h 10_�-
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Building Permit Application RECEIVED
Planning and Development Services MAR 2 8. 2U.16
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: 0/ W r o
Legal Description: - BE4 /40 F b
PropertyTax ID#: 2,36) — 0010 - 000 -o? Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF-WORK:
laCl n 18�� �ov-a P .2oor.
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CONSTRUCTION' INFORMATION:
Additional worK toe e orme it under t is perm -c ec a app y:
HVAC 11 Gas Tank Gas Piping Shutters E]Windows/Doors
EElectric 1:1 _Plumbing HSprinklers EGenerator F]Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ UtilitieslnSewer OSeptic Building Height:
OWNERAESSEE: CONTRACTOR:.
Name-JName: J O n : Lip p oe
Address: -30 !v Aecar Q; Company: +P Gt P
City: In.,' C, 4 State: Address: &J? ✓/o
Zip Code:=?gF9a Fax: R/ City: _S L Stater
Phone No. 336-33oP(n Zip Code Fax:
E-Mail: Phone No. 7 7
Fill in fee simple Titie Holder on next page(if different E-Mail: C-,
from the Owner listed above) State or County License: 98L5Y3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
.SUPPLEMENTA(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 TITLEHOLDER: _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 re Notice of Commencement.
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_Signat a of ner/Lessee/Agent Sign re of Contractor/License Kolder
STATE OF FLORIP STATE OF FLORIDA
COUNTY OF Wo COUNTY OF r
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g g "L a The forgoing instrument was acknowledged befor =o
The for oin instrument was acknowledged b
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Personally Known O duced Ide tificatrn Personally Known OR Pr duced Id ntific ion
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS