HomeMy WebLinkAboutPermit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit APPllCatin
Planning and Development Services
Building and Code Regulation Division
2300 Virg inio 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: ! h
Legal Description: t L d�
Property Tax 1D 4: 33x2,= 6 I- 4U — QO- 7
Site Plan Name: Lot No.
Block leo.
Project Name,
Setbacks Front Back: Right Side: Left Side:
'`D�TAiL�� aE�cRlpT�oN of tn�oRl�:
EONSTRUCT10N II ORI ATI N:
R 1tiona worR toe e arme un er t is peril c ec a appy:
HVAC � Gas Tank Gas Piping Shutters Wird
ows,�Doors
Electric WIumbingn Generator � Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: ti
Cost of Construction: $ �jJF'
-� _ Utilities: 0 Sewer 11 Septic Building Height:
I OWNER/LESSEE:
Dame cs ���rrnn
Address; T?34 4rjeeve
City: State: 1
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: �p"
Company: C nevi gefUby_. Tn c
Address: 0 S� za1--ib,v
City. State: FLI
Zip Code: 39R Lz Fax: 35-D,1690
PhoneNo._
E -Mail: (S;eres`ssPLVr��s�" Se�rltces U
State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
QESiGNER/ENGINEER: z Not Applicable
Dame: MORTGAGE COMPANY. Not Applicable
Address: Name:
City: Address:
Zi State: City:
ZIP: Phone: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: Not Applicable
Address: Name: �`
City. Address:
Zip: Phone: City:.
Zip: --. Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
Which is in can, 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 1 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: roam additions,
signs, screen rooms and accessory uses to another non-residential use
accessory structures, swimming pools, fences, walls,
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
cammencin work or recordin our Notice of Comrnencemcnt.
�Ignature of Owner/
re of
STATE OF FLORIDA.STATE OF FLORIDA
COUNTY OF S �_ .v COUNTY OF S-/ ,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 204 by this day of
Z(} 6 by
(Game
(Name
�. a r+area!#o+ayservice.cxirr 1 iary
Personally Known .. OR Produced Identification ,r Personal) Known
Y DR Produced Identification
Type ��Produeed ype tion Produced
Commission No. (Seal) Commission No.
(5ea1)
Revised 07/15/2014
REVIEWS 1 RONT ZONING SUPERVISOR PLANS VEGETATioN SEA TURTLE MANGROVE
E COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
COMPLETE
INITIALS