HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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) 467--1578
Commercial Residential V
PERMIT APPLICATION FOR: To Select from drop ox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:A
",*I,e 'X
4e�e-11_1_ 1&� z
PropertyTax lD #: W2q-762-46-4Y-00o-(1
Site Plan Name;
Project Name -
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
/alp Ia-c'e— allf.? el-ec?"ric VV,; +Cr hl -14 +e- r
Lot No.
Block No.
CONSTRUCTIOUNFORMATI-ON:
Addtflonai work to be ertormed under this permit- check all appl-,-
HVAC Gas Tank 0 Gas Piping
Shut ie rs Windows/Doors
Electric ["A Plumbing OSprinkliers
a Genirator Roof
Total Sq. Ft of Construction:
Sq, Ft. Of First; Floor:
Cost of Construction. $ Utilities:
Sewer" Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Addre5S;_a(qL_96,(*.h WaN4fl- r*
Company: GPnft;-i& 1,1111
City: fwy-H tuti-e-
Address- ft)_ SC toWoki Ave.
ZipCode: 3YRSZ Fax:
City: Pbr-t Sid L_,J elp-
Phone No. ?�`7-
Zip Code: 34952- Fax: 7721335_ (19
E -Mail:
Phone No. _7'7J-?;?7-3(6SZ
Fill in fee simple Title Holder on next page if different
E -Mail: G,_ne5_tsP1,QrQ1*_
from the Owner listed above)
State or County License: G
I If value of construction is $2500 or more, a RECORDED Not -ice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN i_AW INFORMATION:
DESIG`,VER/E1dGINEER:
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:
Mame:
Ad d cess:
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 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 pians, 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 your Notice of Commencement.
—mature of owner/ Lessee t
STATE OF FLORIDA,
COUNTYOF S_ �•„c;`
The forgoing instrument was acknowledged before me
thisday of �%7ut/ 2C �by
i
(Name 9 5
o6xck_pcQ6dgiryg'f
Sig- pta Fiu i�rIc`�Lye ofolnda j
8-0 5] afatlaNp!a ySBrviLy COR
_ Personally Known OR Produced Identification
Type 'Produced
Commission No.
(Seal)
eo ' _ s
65ignature of Contractor license Fi-
STATE OF FLORIDA
.
COUNTY OF S_ f / e
The forgoing instrument was acknowledged before me
this .20
L day of P -N 20 A- by
s
(Name 4 eraon ing 4,
AN R
Personalty Known OR Produced identification
I ype or ita`-�fion Produced
Commission No.
(Seal)
Revised 07/1512014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
0