HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:1 rho Permit Number:
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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 X
PERMIT APPLICATION FOR: 1 �
PROPOSED IMPROVEMENT LOCATION:
Address: 01017 6 ®Ga4/�1i Lbg- - /0,0 Cf
Legal Description: f eQAF- l`Ohq+nmi' 11 - n/ t ! QJ7d l�L� 5 /ZP__Property Tax ID#: 4,202-50340103-000- 9 = Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric X Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ -.Ob.0 Utilities: _Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name f''���.�f!}�� f+ Name: ,.Wc- W(In 6co,
Address:_ a � �1 P� Company: ;' ' Ayy\ai ca
City: Ca0 &L 61 71' State:F\- • Address:a (e r-d e-T
Zip Code: Fax: City:A koud ' Qf e State:-F—L
Phone No. 9', I4 Zip Code:_333c'-fl //-�Fax: 1s4-972-_35 61
E-Mail: Phone No. S4- T39- /lOD x 5(a73
Fill in fee simple Title Holder on next page(if different E-Mail: !J
from the Owner listed above) State or County'License: 1 Pe os 87
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
,SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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. 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 Netice of Commencement must be recorded andp ed on the jobsite
before the first inspection. If you i to d to obtain financing, consult with lender or a at orney before
commencin w k or recording ur Notice of Commencement. /
s
_Signature of�ORIDA
ner/L s e/Agent Signa#ure:of ontracto%License="-de
STATE OF F STATE OF FLORI A � t`�
COUNTY OF �P-9W COUNTY OF
The forg"gng instrru t was acknowledged before me The forgoing instru ntff as acknowledg d before me
this day of �1 b 20 �by this , day of W 20 �6 by
(Name of person acknowledging) (Name of person acknowledging
(SignatureNotary Public-Sta of Florida) ignature of No ary Public-State o Florida j
Personally nown�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ;i�'�'P�Qf: SHEFF���A YTE Commission No.
MY COMMS FF 065032 '" MY COMMI t FF 065032
.: : ,
;•, :o EXPIRES:October 21,2017 = EXPIRES;October 21,20
,,X F"O� Bonded Thor Notary Public Underwriters ' eE F°�' Bonded Thru Notary Publ'w UndenwrRers
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS