HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( `
Date: Permit Number: ! Z\7
•
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
PRO'POSELP'ROVEMENT LOCATION. xY
Address:
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
t r#'a''ao-3x aSt.. '&i 3#4v 's.1f€ tkF'.4`e .Y3',• ;.'...Y ,� .. e ' ""Ri f (:' .,j t t -&. 2. zti W
DETAILEDDE�SCR'IPTIONOFWQRK
V �},r�,% T,'7. ,fir+
t_
Sc
x cw.AYry.�',� � i ., 4 �, y➢9 ;i. f t?4 a r .1 't;. x.e � f ,;. § e'. �x ti§ i �` `,
COpI�lA7STi�IJ; TIOfV 1NFORMATIOIV` ^ f x
w' s
Additional work to be nertormed under this permit-check.a appy:
❑JHVAC Gas Tank ❑Gas Piping Shutters
❑Windows/Doors
Electric 0 Plumbing ❑Sprinklers ❑Generator ❑ Roof
P ;
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$._ 1� ,tw Utilities: _ Sewer❑Septic Building Height:
CO. ITRACTOR
OWNER/LESSEE R f 4a
::5ksl,. S ,s, e. v•a; s ,g_ '^r-.t.. •iN
Name - C2 CS(O � jt Name: ' 6 OC,
Address: S k P Cornpany: C_
City: e_' `` State: Address: LA6 �
Zip Code_5L-F(4(P Fax: City: %, Statelr� I
Phone No,'�2 3-1 l - �l I I Zip Co.de: OLS-C1 6-z-r Fax-: I I C_- �n�-`-t
E-Mail: C)00f:,hX) Phone N
Fill in fee simple Title Holder on next page(if different E-Mail: S G QO
from the Owner listed above) State or County License: (_CX�)V D W__V5
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM`ENTAL�CONSTRUCTION LIEN LAW INFORMATION:
r..
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. LucieCounty 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 work or recording our Notice of Commencement.
7!!� ';� s
_Signat re Owner Lessee/Agent Signa u of Contractor License Holder
STATE OFF RIDA STATE OF FLORIDA
COUNTY OF c �_ COUNTY OF
The for ing instru, ent wa cknowledge efore me The for oing instru ent wa�cknowled a before me
this ay of 20��by this day of 20� by
", X'k_a_�
a e of person acknowledging) (Name o person acknowledging(IAI(\�,,e��' L �I_v
)
J
(Signature o_f_N_otary blic-State of Florida ) (Signage-af-N Public-State of Florida)
Personall
�� �, %Q&ppl.lNentific tion ersoynal��jt,iGngw d ced Identification
e of Id �fy,rA�t W0 -state 01 Florida Typei ��tiv Prod
* • Commission FF 234730 .+ !� otary Public-State of Florid
Com missio, Comm.Expires Ma� 7aa019 Co p,. ^A,.,Commission#FF 234730 al)
'9r 9 'assn. ''��°���°�`�� sBRI xRl p
°;,;:°`'
Bonded hNational otary Bondedthrow h May 27,2019
9 National N� Assn
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS