HomeMy WebLinkAboutBuilding Permit Application I i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,/(n
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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2300 Virginia Avenue,Fort Pierce FL 34982 j
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P.RQI?OSED IIViPROVEMERIT LOCATION:_: 'f I
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Address: 77S? wbua Cl R
Legal Description: ��� I q P ufl it G eUV\b eia
Property Tax ID#: 332 -760 "0010 00-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTIOWOF.WORK
of 50#
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,CO, STRUCTION INFORMATION
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Additional work toe e orme under this permit check a t t appy:
❑HVAC E]Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ®Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 935 Utilities:0_Sewer❑Septic Building Height:
OUIJ.NIt LESSEE CONTRACTOR. Ij�m
Name Je ki VI to d90v'1 Name:
Address: GtePAl C;1k Company: I C
City: t�_ S L,cec a State: Address: r 12q j, y� e
Zip Code: 3Yq?G Fax: City: State: F�
Phone No. 609- 8615- 60113 Zip Code: Fax:
E-Mail: Phone No. W-1,—n7 C? Q
Fill in fee simple Title Holder on next page(if different E-Mail: .�D2 N't 0Q, CO k'1
from the Owner listed above) State or County License: crz PAI DO
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:SLlPRLEMENTALCO.NSTR.UCTION LIEN-LAW INFORMATION.
DESIGNER/ENGINEER: Not ApplicableMORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: l
Zip: Phone: Zip: Phone:
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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:lroom 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 Fender or an attorney before
commencing work or recording our Notice of Commencement.
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_Signature o Owner/Lessee/Agent Signature of Contr for/License Holder
STATE OF FLO IDA ' STATE OF FLO ' n
rr -- COUNTY OF
COUNTY OF �. �.t�.C`�Q
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The for oing instrument was acknowledg before me The forgoing instrument was acknowledged�j rrthis'J9 day of M 20` by thisdayof 20 L 1a 3d�i� i
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(Name of person acknowl dging) (Name of person ac riowledginig) on�10
{(Signature of Notary Public-State of Florida) (Signature of Notary Public-St to of FloridaPersonally Known OR P ducgd Identification �I. Personally Known OR Qrbd d (Identification
Type of Identification Produced lid\ \` Type of IdentificationiProduced —
(('' Commission Noa__ \l �' (Seal)
Commission No.1'Ir q I. •,••,�,•� �)
ro erG• N%otary Public State 01 Florida radar k,
• ' Monica Chambers
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oiF%P Expires 09/30/2019 10373 �of`opA' :'• FF 10373
Revised 07/15/201 �•� 2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS i ��
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