HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 �1
Date: (P` ( / Permit Number:
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Building Permit Application RECEIVE
Planning and Development Services JUN 7 �ots
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT AP PLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOS,E,D IMP'-,ROVLMENT LOCATION.
Address: I 4b E�) \ isA
Legal Description:
Property Tax I +D#: 1�2�, I` - CJS-��-1- C�- C) Lot No.
Nan Site Plan Nae: Block No.
Project Nami:
Setbacks Front Back: Right Side: Left Side:
DETAILE"PESCRIPTI;ON OF 111/ORK
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CONSRM
TRUCTION INFOATION } ,
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itiona wor to be pertormed under t ispermit-,heck arJtappTy:
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HVAC Gas Tank Gas Piping _Shutters Windows/Doors
WElectric 0 Plumbing ❑Sprinklers Generator F] Roof
Total Sq. Ft of Construction: SFt. of First Floor:
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Cost of Construction:$ 1,�� Utilities: Sewer Septic Building Height:
OW.,NER/LESSEE CONTRACTOR:`
Name 0'4 e LLC Name:
Address: Q Z01 Company: C_
City: u�1-r'' (( State: Address: l
Zip Coder `-1' Fax: n City: �� � Q State: ' r
Phone No.-q, 17_7 F52- L OQ Z Zip Code:`,��1 Fax: 1, 1�C -� - `t &S
E-Mail: I Phone No. m,?- WSI'- �(&
Fill in fee simple Title Holder on next page(if different E-Mail: 11'YQa n
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIE--,CAW 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: I Address:
City: City:
Zip: 1 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 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 structi res,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
commencin ;work or recording our Notice of Commencement.
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_Signa of Owner/Lessee/Agen ;a;;:. Signa of Contractor/License Hol er
STATE OF FLORID �' m� STATE OF FLORIDA o
COUNTY OF �'!i" -08= COUNTY OF m�
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9 PED 2 rnizm
The for oing inst t was acknowledge before 9 �o= The for oing ins ent was acknowledged,bef "'N W
this day of J 20 by fi T this y day of 20 (ppb a z
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(Name of person acknowledging) ( ame of person acknowledging)
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(Signature o otary Public-State of N orida) (Signature of Nota Public-State of Florida)
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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