HomeMy WebLinkAboutBuilding Permit Application a+ L
ALL APPLICABLIE�INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVF r",
Building Permit Application JUL - AV)-S'
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)1462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT AP�IklCATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED}IIVIPROVEMkENT LOCATION .:
Address. 1� t \�l:luy\ F I Lo
Legal Description:
Property Tax IID#: � `-�� l(�1 -� 5� 'r� Lot No.
Site Plan Name: Block No.
Project Namel.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O'F WORKdCrJ(__ W� U!g-
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CONSTRUCTI"O'N�:INFORM AT IO.N
Additionalwork to a er orme under this permit-check a appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: SFt.of First Floor:
C7 O Utilities: Sewer Septic Building Height:
Cost of Cons truction:$
OWNER/LESSEE ".CONTRACTOR
Name Name:
Address: Company: L
City: 1 State: Address: t� l7A VA
Zip Code: 549 i-�-1�/ Fax: City: 1 � Stater
Phone No. Zip Code: (( Fax_J-]�_- y( �
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E-Mail: Phone No. -T17 - CA -
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Fill in fee simple Title Holder on next page(if different E-Mail:, QkY�QS -i c in('Acyl C. YY)
from the 01wrier listed above) State or County License: Cc5nUcq�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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: I Name:
Address: I Address:
City: City:
Zip: I Phone: Zip: Phone:
I
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 structiures,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 'iwork or recording our Notice.of Commencement.
_Zz� s
Signature ner Lessee A ent Signat of Contractor/Licens
g / / g a'
�
STATE OF FLOR STATE OF FLORIDA
COUNTY OFa m� COUNTY OF
e 96 8
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The for oing instr ent was acknowledged befo for m The forgoing ins ent was acknowledged befo �
this day of 20��by this day of 20 hp b �
fDV� W/ �/✓�(�C� A Sx�
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a e of person acknowledging) a ( a e of person acknowledging) a oA
CD
N
a
ignature of ry Public-State of Florida) (Signature of N ,y Pu/blic-S ate of Florida
Personally Known/ OR Produced Identification Personally Known v OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/11I5/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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