HomeMy WebLinkAboutBuilding Permit Application ALL APP CABLEJNFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
j�
Date. Permit Number:
61..,�'z`•�z������ - - -
s .
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Av!nue,-Fort Pierce FL 34982
Phone:(772),462-1593 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOS�D�4,.IMPROVEMENT,LOCATIO,N:
a - 1a
Address:
Legal Description. r .
Pioperty Tax ID#: Lot No.
Site Plan Name: (� ' Block No.
Project-Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE$'MIPT5'dl4 OF:INORK "
CONS",TRUCTION INFORMATION
,
AcIditional work to be rmed under tispermit-check all appy:
In
HVAC,, Gas Tank ❑Gas Piping Shutters indows/Doors
�ecttic �Plambing •Sprinklers Generator _Roof
�:
1
..Tota Sq Ft of Construct?onc S . Ft.of First Floor:
Cgst'of Constryciion:r$ Utilities: _Sewer[]Septic Building Height:
'DINNER/LESSEE r y
m °CO'NTRAC'TOR.
Name - Name: -
Ad ss: Company:_ f ` 1-`
Cit ' State:T( - Address:`Id
ZipCode3-mb Fax: Cit ,����� �`� J State: Win`
Phone-No. `i -.�y�-- .-a , � Zip Code: Fax::
E-Mail: ,) Phone No. -AK) 1� ]
Fill in fee simple Title W
rO on np'xq page if different E-Mail:
from the Owner listed above) State or County License:'
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL•CON STRUCTION LIEN LAW INFORMATION°` '
DESIGNER/ENGINEER: kA of Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: UNot Applicable BONDING COMPANY: of 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
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.
s
_
Signature of Owner/Lessee/Agent -Signature of Contractor/License Holder
STATE OF FLORIDA/11� STATE OF FLORIDy
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instru[ngnt was acknowledged before me
this V day of Q 20( by this�day of /Mu— ,201 by
(Nam o p r on acknowledging) (Na a of pp on acknowledging)
(Signature of Nota -State of Florida) (Signature of Notary bl• State of Florida)
• ~I •. IW�P•
Personally Known _ Pro Personally Personally Known ;�• •`t�Prod���� r '
Type of Identificat ' '�Y COIR Type of Identificati ri , Cf Ibl ALLEY
(ao7)39"753 EXPIRES 25005 '� ON#EE225005
r EXPIRES�
Commission No. Frog, _?522 04.2018 Commission No, (aorj ea� Frorreer�, rOq,2016
oe.rnm ryservice.e�
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS