HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 s
Phone: (772)462-1553 Fax: (772)462-1578 Commercial 'Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IIVIPROUEMENT LOCATION
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Address: YO
Legal Description: I
Property Tax ID#: X301 0()(4 •O613• Doug Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION QF WO,,RK � � £ � � "` s. � F
CONSTRUCTION INFORMATION ''
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Additional work toe e orme under this permit-check a apply: yI
1]HVAC E]Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 1:1 Plumbing Sprinklers 1:1 Generator EI] Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction:$ % Utilities: _Sewer[]Septic I Building Height:
OWNER/LESSEE CONTRACTOR ,. ,
Name Name: it-- c le
Address: 9�%®�/ �� ��- :� Company: def4 w.
City:_ �% U.f ,__ State& Address: �,1y Old ,0 ���-
Zip Code: .39fyS`/ Fax: City: //_ /S I State: TZ
Phone No. 7 Zip Code: 3,46 1�,/ Fax:
E-Mail: —
Phone No. 7;7.2
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C,46 C Ce q�
If value.of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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• Sl7PPL�LVIENTAL CONSTRUCTION�LIEN,rLAW INFORMATION f,--` - t � �
DESIGNER/ENGINEER: _Not Applicable � COMP, N
�•� �`_ �� �•:
pp MORTGAGE COM _Not Applicable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: i
Zip: Phone: Zip: Phone:
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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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_Signature of Owner/Lessee/Agent Signature of r
add!r/UcenselHolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �e, COUNTY OF jriC�i G vel r V �'-
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 /(by this_(9-C1 day of PrD ff 20 L by
CJYK X11 er Uc�orn.
(Name of person acknowledging) (Name of person acknowled ' g)
(Signature of Notary Public-State of Florida) (Signature ofNcftaubIfRc-State of Florida)
Personally Known OR Produced Identification V'I' Personally Known OR Produced Identification
Type of Identification Produced_)'I- 01, e y I-3-/? Type of Identification Produced r-L OLEric Swqnson
l»S�bS�1S 8333
Commission No. NOffiv Pu
BLIC Commission No.lr-1 SA93
EMISTATE OF FLORIDA ;•�o�""�°�A�;,- MELISSA V DIN
o ary Public-$ta of noric
Revised 07/15/2014 Expires 8115/2019 I Commission#F 921563
qMy Comm.Explrea p 24,20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION I' SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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