HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: 3 �� Permit Number:
RECEa'.� AUG 3 2UiSi
EI
0
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 b (t� e w q
PROPOSED lM Rd, -ENT LOCATION:
Address: :R��L4 S 148,0 V Lra. L
Legal Description: :�LJ 1 b 6 U 6 O O —
iAP, _i_ILL-I
Property Tax ID#: _;i j�'~�'I6 d L/-- 000 Lot No.
Site Plan Name: _ Block No. f
Project Name: 1 fsrE 2 f�
Setbacks Front Back: Right Side: Left Side:
DETALLED DESCRIPTION OF WORK:
6 ki m alit'i tl6 u)Rz
X006 PZZ W 1 .i t-/
ONSTRUCTL:ON IN;FORiVIAI'ION
rtiona work toe e rme under this permit—check a appy:
HVAC 13 Gas Tank ❑Gas Piping Shutters Windows Doors
Electric 0 Plumbing SprinklersGenerator Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ c� L4O0 - 00 Utilities:11Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name G 1z A4 (, 1 Name: .y
Address: �-l4A I�� " k Company:
city: 'y' S'�- Zc l?L State:-d4 Address: d— S Lv oc+4
Zip Code.a Ll` Ea Fax: City: j,�y State
Phone No.�� � >UcP—�`7(�,j Zip Code:X4-1Q � Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail-4,/-wi- &,e f /92>2 �
from the Owner listed above) State or County License:
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 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: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 RecoCd a Notice of Commencement may result in your paying twice for
improvements to your property.A NAW of Commencement must be recorded and postedon th o e
before the first inspection. If y d to obtain financing,consult with lender or an attorney 'e""'e
comme cin ork or ecor . r Notice of Commencement.
s
Signat of Owner/Lessee/Contract s Agent for Owner SignatuVFLORIDA_
cto icens der
STATE OF FLOR�DA STATECOUNTY OF S - uL � " COUNac
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiR>\ day of , 20 W by thi;M day of 20 by
(Name of pe on ack owledging) (Name of persona knowledging)
(Signature of Notary Pu c-State of Florida) (Signature of Notary blic-State of Florida)
Personally Known OR Produce Rg Personally Known
Type of Identification Produce AR��o 023 Type of Identification I o :• � ppMpR�EG
W145S�����16,20 �� =t} MY CO Mbet 16 2020
Commission No. P��Q�brc��de� Commission No. o I d80: Pd lour erwrfters
Sm-deea., oPe BeOdedN o ,
Revised 07/15/201.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS