HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nurnber:
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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 CorhmerCial Residential
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PERMIT APPLICATION FOR: To Select from dropbox click arrow at the:end of line
PROPOSED IMPROVEMENT LOCATION
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Address: 3��1� . U F S' :: .. .. e,
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Legal Description:S l M. ms .
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Property Tax IDs.
I#::_o�:'T _ ��a� -' ®��"-=�f �® Lot No.
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Site Plan Name:; Block No.
Project Name:
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Setbacks Frflnt Back:: -I Right Side: Left'Side: i
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DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION: -
.Additional work to be nertormed under er t .is.permit-c ec .a appy:
OHVAC: �: : Gas Tank :. Gas Piping: Shutters: o windows/Doors
Electric 0 Plumbing Sprinklers Generator:: Roof
Total Sq. Ft-of Construction: S . Ft.of.First Floor:
Cost of Constriction:$ �C1 00 Utilities: Sewer❑Septic Building Heiglit: j
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OW N ERAESSEE CONTRACTOR
Name Name.:. �vrn SG4nSC►�.. :..
Address:13�D48 -AUE S, .Company:
City:F+, Pi e�e_, State.:. I Address: ie.
Zip: 3 .Code- "I 4 T Fax:( LJ �� : City: .066 b State: F�
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Phone No.
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- -. _. Zip Code: 3Z8,i'a ...
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E-Mail: Phone No: 190
Fill.in:fee simple Title.Holder on next page(if different E-Mail:
from the Owner.listed above) . . . ... State or County.Licenser
If value of con i ruction is
.$2500 or more,a RECORDED Notice of Commencement is required: ::
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: : _Not Ap I' able _
MORTGAGE COMPANY-: -"'Not Applicable
Name: ��5- �� �' Name:
. .
Address:%` ,S�
Address::
City/ Stater y: State:
Zip: 00R/0 Phone: L qA3 53 Zip: _ . . . Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:. Not Applicable'
-Name:
.. .. .. Name:
Address: Address:
City: City:
Zi Phone:
Zip: - Zip: Phone::
certifythat 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 orprohlbit such
structure. Please consult with your Home Owners Association and review your deed for-any restrictions which may apply.
In considerat"ion,of the granting of this requested permit; I do hereby agree that l 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,swimmingpools 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 yodupaying.twice for
improvements to your property.A Notice of Commencement'must be recorded and posted on thejobsite
before the first inspection..If you.intend to obtain.financing; co suit . ith lender or an attorney before.
commencing work or recording our Notice of Commencemen
s
_Signature of Owner/Lessee/Agent : Si n ture.of Coritr4ct Lic older.
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STATE OF FLORIDA STATE:OF Col.e 7 0
COUNTY OF COUNTY OF DeAvec :
The forgoing instrument was acknowledged before me The forgoing:instrument was acknowledged before me
this day of 20 by this .'k: day of F6E 20 1.(, by-'
(Name:of person acknowledging) ( , e of person ack wledging)
Signature of Notary Public=State of Florida) ( ig re of otary Public:Stat )
Colocodo .
Personally Known. OR Produced Identification Personally Known x OR Produced Identification N�
Type of identificaion Produced Type of Identification Produced WIA
Commission No. (Seal) Commission No.7_60,-,�gk62g0SJ (Seal).
CHARLENE P. CLARK
Revised 07/15/2014. NOTARY Pu8LIC
STATE
N OF COLORADO
_. OTARY td A 2n
XPIR``RIL 1.5,20
REVIEWS FRONT_ _ ZONING SUPERVISOR PLANS VEGETATION . SEA TURTLEig1VRO
COUNTER REVIEW REVIEW REVIEW REVIEW .: . REVIEW., REVIEW
DATE
COMPLETE V.
INITIALS