HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
r
Date: J u� Z� ��( 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) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: -Y C)
Legal Description:
Property Tax ID#: / 7Z6` kH02 —COQ 1-7' 000 e 0.5
Site Plan Name:
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No.
Block No.
Aaaitionai worl(to pe ertormea unser this permit- check all that apply:
E2ctric
GasTank F]Gas Piping CGenerator
Shutters Windows/Doors
❑Plumbing ❑Sprinklers Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $�}(� (� Utilities:�Sewer Eheptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 60'sctt) a(;VrLeAc P
Name: CV ll� C
Address: ?�G') 1 t -,J el a
City: �T: Lcac.irj `A)lci/ State:_R
Zip Code: Fax:
Phone No.
Company: Vvs' j �� cc��1 (� - C'4 j (1s
Address: -7`jL bjit 2 <
City: OL'rt Lt'ci1- State:_
Zip Code: 5 q l-'�1j Fax:
Phone No. %7Z-3 70 - &69
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: z ( C111 I'i.5 -;5-?6ii6-f / , /`%� I`
State or County License: E L 13 W 7
IT value oT construction Is $ZWU or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commenciniz work or recording your Notice of Commencement.
G 5
_ Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder o
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20 _by
STATE OF FLORIDA
COUNTY OF 57- L LCC- iE
The forgoing instrument was acknowledged before me
this PW day of -r'-' �—y 20 / (- by
(Name of person acknowledging } (Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014
(Signature of Notary Public- Stat of Florida )
Personally Known G--- OR Produced Identification
Type of Identification Produced
Com
4Y CO!Tk.4[SIONk Frwi�,
FViRM: Fd ruory 2d, zs+i,
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS