HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date; 1� 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address
Legal Description: �3S3�t—
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Property Tax ID#: (.SOU l o w C- Lot No.
Site Plan Name: Block No.
Project Name: ReWInc,n
-Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: I
ACICHtional work to be erformed under this permit—c ec a i appy:
HVAC Gas Tank ❑Gas Piping
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nFr_Shutters ❑Windows/Doors
Electric Plumbing Sprinklers Generator �iRoof' ,Roof pitch
Total.Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ e;_019/1 Utilities:oSewer Septic Building Height:
OWNERAESSEE: CONTRACTOR: i
Name Lq Name:
Address:70/ So—g e�A k_rt 5 Company:
City: cf. e.� -c State: Address: I
Zip Code:3 u q-( Fax: City: State:
Phone No. -?72- 5 0 1 . ol-00U Zip Code: Fax:
E-Mail: 6zik aC__ �� oc.-tloo�. . C-O(LA Phone No.
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.
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SUPPLEMENTAL CONST,RUCTION: LIEN-LAW�INFORMATfON Y -
DESIGNERANGINEER: ^Not Applicable MORTGAGE COMPANY:;, Not Applicable
Name: Name:
Address: Address:
City: State: City: - `1I —State:
Zip: Phone: Zip: Phone: I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: 'j � Not Applicable
Name: Name:
Address: Address: 1
City: City: ! !
Zip: Phone: Zip: Phone: ',1
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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 holder10 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 i' 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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4reSignatof O ner/L ssee/Contra r as Agent for Owner Signature of Contractor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA j
COUNTY OF � a�,a Q COUNTY OF dI
The for oIng ins ment was acknowledged before me The forgoing instrument was acknowledged before me
this day of _ 20 -&-by this day of ,20 by
(Name of.peison ack wledging) (Name of person acknowledging')J
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( ignat re of Notary Public-State of Florida) (Signature of Notary Public-State! f Florida)
Personally Known OR Produced Identification Personally Known OR Produced;Identification
Type of identification Produced Type of Identification Produced
- ',� (Seal)
Commission No. •�„���� , a LASHAHNA iNBpmrrii ion No.
Notary Public-State f Florida,
Commission#FF 177249
Revised 07/15/2014 "%%$;,; Bonded through National Notary Assn.
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EVIEWS FRONT ZONING SUPERVISOR. PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEWREVIEW REVIEW
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