HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 - ,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address y_)`: t�YL�S 6CV\
Legal Description: -n ok
Property Tax ID #: �C�l ��� - �dCC) ' Com+ Lot No.';� Q
Site Plan Name: Block No. 1_
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CSI _rT_ G CXESTId� ?j ��i
iU 5 �:ial work to be rlli�iri::rieil under this permit -check all apply:
HVAC Gas Tank FGas Piping _ Shutters 11Windows/Doors
❑ Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Constructioonn: S Ft. of First Floor:
Cost of Construction: $ { )��U�rj Utilities:Sewer Eleptic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name 1 c -
Name: Mn -4 A7
Address? -F-10 (
Company:
City - State: f:�
Add r s:
Zip Code: C) Fax:
City:(Yc h State:111
-2
Zip Code: L Fax: �'��'
Phone No.
E -Mail:
Phone No.___T
E -Mail: C
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: l—ACi Rt V?) `-t L2
If value of construction is $2500 or more, a RECORDED Notice or Lommencemeni is requireu.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 your Notice of Commencement.
_s
_ Signature of Owner/ Lessee/Agent
Si a `ure of Contractor/License Holder
STATE OF FL STATE OF FL ID
COUNTY OFA %A S(1C�7E COUNTY OF C
The fooing instr ent was acknowledge11 Pefore me The forgoing instr ent was acknowledged before me
thisday of _ r 20 j by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging )
(Sign_ ture of Notary Public - Sat of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
CLAY MCNABB
MY COMMISSION 0 FF961;
EXPIRES April 12, 2020
A ; rc'nu� %4'01t'jib —
(Sig ' ure of Notary Public- S to of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
mission No.
im
CYNTHIA CLAY MCNABB
EXPIRES April 12, 2020
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