HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
i
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 l„
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR:
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PROPOSED IM;R`R01/EMENT LOCATION_ 4 � `!,� r '�'' �;� �' 4
Address: 1 V the
Legal Description:
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Property Tax ID#: Lot No.
Site Plan Name: Block No. Z
Project Name:
Setbacks Front Back: Right Side: Le Side:
::DETAILED DESCRIPTION,OF WORK �"Y �� k, � SI ,,I F
' 44
-CON 'TRUCTtONfINFORMATION
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Additional work to a pe formedun er t is permit-ch ec a t at appy
—HVAC Gas Tank Gas Piping Shutters
p g — 11 Windows/Doors
—Electric —Plumbing —Sprinklers —Generator I
oof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ / Utilities: —Sewer —Septic (Building Height:
7 r�i-
Name �
Name: 20
Address: �.� 71Cc Company: tJ \` 11 Z
City: "ey to- State.-E Address: 'P
Zip Code: Fax: City;
State:
Phone No. �- IcJ Zip Code: / Fax:
E-Mail: Phone No. 5� 0i,01793
Fill in fee simple Title Holder on next page(if different E-Mail: ( lUe
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. �'�
SUPPLEMENTAL CONSTRUCTION LIEN LAW
INFORIMA[1UM.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: I Not Applicable
Name: T Name:
Address: Address:
City: State: City: —State:
Zip: Phone: Zip: Phone:L
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: I Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone: i
11
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 i the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants venants th,at 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
I.
in accordance with the approved plans,the Florida Building Codes and St.Lucie CountyAmendments.
The following building permit applications are exempt from undergoing a full concurrency review:1 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 lin 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 your Notice of Commencement. — 1 I,
1),IML4 s
Sigtune of OwnerPsSeEAgent signat&-4 of_Contractcj/0mmse-,R�er
STATE OF FLORID� STATE OF FLORIDIA
COUNTY OF COUNTY OF E72, ILX e
The forgoing instrumgDt was acknowledged before me The forw instrument was acknowledged before me
this day of_M�)lllllk 20 Vio—by this Ill day of 20 Lb by
(Name of person Xcknowledging) (Name of person ackhowledgin—g'")
(Signature of Notary Pu bfic-State of Florida) (Signature of Notary Ab I,lie of Florida)
Personally Known R [Wured_IdentLflcation Personally Known
rodu I
Type of Identificatio r us RA A D9 6A 6UZ VEhAsee Type of Identification Not:I :
- I I bill,
Notary public-State of Florida my Comm. E ires Nov 1,2016
Commission No. Commission No. Comise�R),#EE 848616
MY020.Expires Nov 1,2016
Novlov
.,,OFF Commission#EE 848616 Bonded Through,;National Notary Assn.
Bonded Through Natinnal Not&
voll IV W
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VU31:1A111ON 1i SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS