HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: _
•
RECEIVED
Building Permit Application MR ° 1 2016.
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: `-F1
Legal Description: 30. 13)a aw
cy('V 0-
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:, .
Additional work toe performed under this permit-check all that appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric IJ Plumbing ❑Sprinklers ❑Generator ❑Roof
Total Sq. Ft of Construction: (�•'' S . Ft.of First Floor:
Cost of Construction:$- oe'<J V Utilities:Cn Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR-.
Name i Name:
Address: n iv t'g— Company. L
City: i'i P,EC�� State: Address: ,�.
Zip Code: Fax: City: .YI
Phone No. 1 0` ' 1Ql `53 �5 u Zip Code:y� Fax:
� '
E-Mail: Phone No. � oZ• Lo `z) l
Fill in fee simple Title Holder on next page(if different E-Mail: 4--l'tv P ItA 100 c2 DUCE 4P 1-96L• C C%
from the Owner listed above) State or County lacense: C 02
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL 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 TITLE HOLDER: _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 recording our Notice of Commencement.
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_
Sign6ture of Owner/L ee/Agent SignatuA of Contractor/Lic se Holder
STATE OF FLORIDASTATE OF FLORIW I
COUNTY OF ��' , ('_) Q COUNTY OF Q_
The forgoing instrument was acknowledged before me The V
oing instrument was acknowledged before me
this day of I Y �' g C 20 �i by this day of 20 L by
. '
dM4-)JCL
(Name of a son acknow edging) (Naof pe son acknowledging) I
r t `
� l f
gnature of Notary P, -State of Florida) ignature of Nota P t,c-State of Florid
Personally Known `� O Produced Ident tcatio Personally Known OR Produced Identification
Type of Identification Pro uced X M mks pe of Identificatio ro ced
°4�•�ev,'.,
LIBERTY A.KING :PLIBERTY A KING
Commission No. _t., Se�Y COMMISSION#EE 877248 ommission No.
s �(SIM0FIMMISSION#EE 877248
�XPIRES:May 4,2017 �: EXPIRES:May 4,2017
: pF roe` Bonded Thru Notary Puhlin.,Wder!rte Bonded Thru Notary Public Underwriter.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS