HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: l �0 a513
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JUL ? 8
Building Permit Application
Planning and Development Services PCFi lliTrii,!C
Building and Code Regulation Division Si. Lucie County!_
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2300 Virginia Avenue,Fort Pierce FL 34982 � J
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
SPR POSE.pp IMPR01/EMENT I"O�CATIO�I 'µ
Address: L
Legal Description: "'i(?c-'7sk 1 '
Property Tax ID#: '7 ����1�—�C�\e,, Lot No.
Site Plan Name: C1 �� Block No.
Project Name:
Setbacks Front Ba Right Side: Left Side:
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�xDETAILED DESCRIPTION
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CONSTRUCTION�INFQRMATION���g � � � �. X ,`
nal work to e e orme under r)G
ermit
❑_HVAC �Gas Tank as Pi in Shutters Winclows/Doors
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Electric Plumbing Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ C Utilities:0 Sewer 0 Septic Building Height:
OWNEkRf LESSEE <} i'x> r. a, SFY CONTRACTOR
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Name ',, k am e: v
Address: Company:
City: ` 'NStater Address: 19 ] ,ve,4 Jt (14o`I
Zip Code: o Fax: City: flop� lS+. State: �L
Phone No..-j7;2:3gac 7 CJ. l.( Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on nex age(if different E-Mail: . SG�ft _
from the Owner listed above) State or County License G 15a
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL,CONSTRUCTION LIEN LAW INF0RMATI0.N
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DESIGNER/ENGINEER: V N t Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: t 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 thepermit 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.
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Al_Signature f Owner/Lessee/Agent signature of Contractor/Li se Holder
STATE OF FLORIDA f l STATE OF FLORIDA ST U01(f,
COUNTY OF -�f LUCA COUNTY OF
The forgoing instrumnt was acknowledge before me The for oing instru ent was acknowledged before me
this )k2day of (✓ 20 U-by this.0 day of 20 k by
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(Name of peso a knowledging) I (Name f erso acknowledging)
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(Signature of Notary Public-St t of F ��,`G 50p5 (Signature of Notary Publi tate of Florida
Personally Known `e �n Personally Known V OR P e}ft`�1f `+�SZ�O
Type of Identificatio oduce bel Type of Identification Pro g�0
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Commission N eal) exp Commission No. =� Y ::M ���
••,°:�9';P`',53 �`o� :•: ;, 3 Flo'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS