HomeMy WebLinkAboutBuilding Permit Application ALL APPMI .:-,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
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential /1K
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED=IMPROVEIVL.ENT., `LOCATION,::: {
Address: ,0 7,9-S_ S 6,f_z*22 Jj� zul
Legal Description: i /�/✓,,�,., ,9-y.7f' ,4 T ��,Lys„� 0I-A- moi- 4o7- y
Property Tax ID#: VX_7 -600 Y Lot No.z-
Site Plan Name: Block No. 4
Project Name: s � S
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF-WORK �=
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CONSTRUCTION .INFORMATION
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Additional work toe er orme under this permit-c haec appy:
HVAC El Gas Tank 0Gas Piping _Shutters Q Windows/Doors
_Electric 0 Plumbing ❑Sprinklers El Generator 0 Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 3 2 7S— 0-0Utilities:Sewer ElSeptic Building Height:
OWNE /LCONTR
RESSEE ACTOR J
Name .� �(,Q(.S Name: lfc
Address: /y72-5- 2. Z L''/ Company: 4 7 7-1 Z-
City: 3 14- - State: W-C- Address: 0 .5'
Zip Code3 �i 07 5- Fax: City: ly ” P State: rL
Phone No.3/ Z- Z-3- - 9 7 2:,/ Zip Code:,�3 (- /.T Fax: SGS 43I/ po
E-Mail: Phone No. SZ,- t-/13 - 7/5 7
Fill in fee simple Title Holder on next page ( if different E-Mail: ?e.2 ni,-,s el 4`Z-C-1 t-4e . C-L�
from the Owner listed above) State or County License: C0t5'ZS`3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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TAL CONSTRUCTIaN 'LIEN LAW I:NF�RIVIATION {
GNER/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 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
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before the first inspection. If you intend to obtain financing, coult with lender or an attorney before
commencing work or recording our Notice of Commence t.
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_Signature jMowner/Te`ssee/4pK Signature o Contractor/L e se Holder
STATE OF FLORID,Ar-, STATE OF FLORIDA
COUNTY OF re COUNTY OF ✓ /
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 Eby thisI'o day of---, 20 ! by
(Nam of person acknowledging)�/W/jp (Name o•person acknowledging_ 001 ) /N
inat
gure of Notary Public-StAe of Florida) (Signature of Notary Public-Stat, f Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Pr ducedd "
Commission No. � Commission No. (Seal)
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Revised 07/15/2014 ' ovsin
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REVIEWS FRONT ZONING SUPERVISOR PLANS VELEIATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVI;EW REVIEW MAN LR
DATE REVI- EI�
PLETE
INITIALS
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