HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFt MUST E1COMPLETED FOR APPLICATION TO BE ACCEPTED '`�
Date: a /CU Permit Number:
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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: o�
Legal Description: / S112
Property Tax ID#: 033 `F��l ��B`/ "`��� Lot No.�
Site Plan Name: Block No.
Project Name: ,
Setbacks Front ? Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
*74�rQ
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a apply:
HVAC E]Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers I Generator 1:1 Roof
Total Sq. Ft of ConstructigV.
/ S Ft.of First Floor:
Cost of Construction:$ �u Utilities:pn Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name M�L"n QUI'/ L Ca
Address: � av 5 r
City: State:f_�l Address:
Zip Code: 3 it��(' Fax: City: �S Stater
Phone No. Z7� �02� Zip Code: 3#5_3 Fax:
E-Mail: /(//t Phone No. 7 ZT1,5162 74;u
Fill in fee simple Title Holder on next page(if different E-Mail: {Z Pte;
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 INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE 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:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Countyy 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 workor recooing your Notice of Commencement.
s
—Signature of Owner/20a/Agent Signature of Contracto nse Holder
STATE OF FLORIDA 1 J STATE OF FLORIDA
�C—�
COUNTY OF ��T� �__ COUNTY OF
Th for oing instru ent was acknowledg d fore me The forgoing instru ent was acknowledg d before me
thi��day of 20��by thi�ay of 20by
1 6,C - - 4
(Name of person acknowledging) (Name of person acknowledging.
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(Signature of Nota Public-State of Florida) � a(Signature of No Public-State of Florida)
Personally.Known OR Produ d t' id Personal) OR Produced Id ti�tion
Typ Type of I rpt+ );iqP r
�'%oy'a" :ter° �a�''- ANGELA M
Co �? Notary Public-State of Florida an Notary public Sta eU eal)
„ FF 2347(�al) Commis
.•? p' mmission ° fr,;
My Comm.Expires May 27,2019 j -'; ��o?;°•'�MY Comm.Ex #FF 234;
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS