HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO 13E ACCEPTED
Date.
l
Permit Number:
Building Permit Application
Planning and Development cervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952
Phone.: (772) 462-1553 Fax: (772) 452-1578
Commercial Residential _V/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 4100 Sh0 _.. {
Legal Description: 4 a ky Gt, F P6A Q l a q Lo
Property Tax ID #: _?33q- 150 - 0 tq q —()00-9 Lot No, �rr
Site Plan Name: Block No.b
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
6 1 e WckE•p } +e r in 12n� c�rc��p
CONSTRUCTION INFORMATION:
Additional work to e ne Orme un er t is permi-t- C -ie
E1HVAC 1:1 Gas Tank E]Gas Piping
Lel Electric dumbing OSprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 5 `w
OWNER/LESSEE:
Name_Qp-pnatnau
Address: p
City: 4 aL Concekes State:
Zlp Code: -j-u &15 Fax:
Phone No.
E -Mail:
all tnat a
I. �I Shutters
IGenerator
SgFt.( of First Floor: _
Utilities-. L]Sewer OSeptic
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
11 Windows/Doors
DRoof
Building Height:
CONTRACTOR:
Name: 'J Tultv
Company: ► r, AAdM6s
Address: A-02 'SE hIld '-
City: port S t, I d co- State: VL_
Zip Code: E252 ... Fax: _712 335-a�90
Phone No. 1-72.- 7-3(.'B
E -Mail: Czer�es�`#�{Virbi Se cvh m am
State or County License:. d
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPL
..... ENTAIw CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/Enfc;iRu_s:; 0
Name-
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Nat Applicable
State:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 holderto 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
commencin work ar recvrdin our Notice of Commencement_
°'Signature of Owner/ Lesseenature of Contractor/ icense H r
STATE OF FLORIDA. STATE OF FLORIDA
COUNTY OF /- Z L. COUNTY OF
The fo4rping instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ri f 20 by this "day of ✓-/ ( -201.6 by
L�� s
Name
son ck64gi (Name ers�o ac ing
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Sig o�jsitiwerevtcoafro or:da) " ary
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Personally Known ,, OR Produced Identification Personally Known , DR Produced Identification
_
yP� e �ti�iotE Araduced ype tion Produced
Commission No. (Seal)
Revised 07/15/2014
Commission No. (Seal)
REVIEWS
FRONTZONING
COUNTER
REVIEW
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
DATE
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
COMPLETE
INITIALS