HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: JUL 2
1
Building Permit Application
PE ;C3
Planning and Development ServicesSt.Lucie county' FL
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
�PROPOS'ED`IMPROVEMENT°LOCATION 4` x a` a
Address: i - tt, L-
Legal Description: 'C V -V
Property Tax ID#:k49 Ql(p —5`0 —00 26 GQ®-Fj Lot No.
Site Plan Name: Ixau n Block No.
Project Name:
Setbacks Front Back:. Right Side: Left Side:
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CONSTRUCTION 1NFQRMATION' d k l, � �
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itiona wor 'to e e orme un er t is permit-c ec.a tbat
r appy1:1 :
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 3 C Utilities:cn Sewer Septic Building Height:
OWNER/LESSEE sX,i s �7, CONTRALTO r
s s..
Name '. Name: I)P
Ad s: �(Sl �" Company: S
City. State: - Addr
Zip Code;SASS�+ Fax: City: State.
Phone No.1-7vL'DY -\\055 Zip Code:� �5 yFax:
E-Mail, 2_c�G-Q\Lc.�C,--,� clt1,, Phone No. Sad �b.�9 S�:l
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTR = C NLIEN LAW INFORMATIONy ;$
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DESIGNERJENGINEER: of Applicable MORTGAGE COMPANY: t Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: k, ot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF LU Lt COUNTY OF C�(
The forgoing instru nt w s acknowledgqq before me The forgoing instruppet was acknowledge before me
this day of 7.01 by this day of t( 20 I by
K&Qbri�
(Name pe son a nowledging) (Name person a knowledging)
(Signature of NotaryPublic-State ol Alorida) (Signature of Notary Public-State o)Florida)
Personally Known roduced Identification Personally Known OR Produced Identification
Type of Identificatio :. .°bid Type of Identificat'
b_ E
Commission No. ' `C` �YC°MQ�I�C�Lc� Commission No �i�t� Seal)
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Revised 07/15/2014 Ce..
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE NGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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