HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (j3�r 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 r -
/ .
Address: 15
1
Legal Description: 2f�+ S a e,
Property Tax ID#: 2–.SOC'"�%��7�CLQ f Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK Y r
: ,. �:
CONSTRUCTION INFORMATION: f '
r
Additionalwork toe e orme under t –checkispermit a appy:
❑HVAC Ei GasTank ❑Gas Pi _ Wi dows/}Doors
Ping Shutters ❑
Electric 0 Plumbing Sprinklers Generator _Roof
Total Sq. Ft of Construction: P� `t �� Sq. Ft.of First Floor:
Cost of Construction:$ �li 00 Utilities:0 Sewer ElSeptic Building Height:
OWNER LESSEE 7 CONTRACTOR s
Name Name:
Address: p ' Ad, Company:
City:`Joe � /." State:. —, Address:
Zip Code: �:3 q-7�5 "7 Fax: City: State:
PhoneNo. �'�5-2� Zip Code: -3 3�si Fax:
E-Mail: ,' Phone No. –7 Z 3�y
Fill in fee simple Titleolder on next page(if different E-Mail:b 14 /x_ = e ap� z�r ,C.Oe'^
from the Owner listed•above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
- -•tea
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 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 recording our Notice of Commencement.
s
_
Signat#of Owner/Lessee/ t Signature 9f oontractor/License Hpl&fer
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF /f( 1� COUNTY OF If�77' �/�I
The forgoing instrurgent w s acknowledge efore me The forgging instrument wasa knowledged b fore me
this�day of ti 20 by this IX-day of 20 f�by
(Name of p n acknowledging) (Name of person acknowledging)
(Signature of tary I c- tate f Florida) (Signature f NotaZ%OR
of Florida)
Personally Known=R Produced Identification Personally Known roduced Identification
Type of Identification Produced Type of Identification Produced
Commission No. s (tfyFRAMPTON Commission No. A ROJtR)j MPTON
MY COMMISSION#FF188186 MY COMMISSION#FFI8 1186
EXPIRES:January 08 2019 EXPIRES:January 08,2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
ftTIALS