HomeMy WebLinkAboutBuilding Permit Application l
ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34952 /
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential t/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the ena of line
PROPOSED IMPROVEMENTS LOCATION:
Address:
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Legal Description: _R,vQ'(dC4 I-e Yu +_ILL (!!�(J la /L s �I 2 S � (�rl i� :���I/� � f l.(f3 Ft"
Property Tax ID#: ZZW09 -Ii J 0 137 000 1 ! Lot No.
Site Plan Name: Block No. r
Project Name:
Setbacks Front J Back: Right Side: Left Side:!
4*L `b.: SC"RIPTION OF WORK
4�5-�-��1 a n��J 67Y 0A6Dad�(e�pora+tc ir)c. ��c-c�c���oo,
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CONSTRUCTION INFORMATION
Additional work toe e orme - under is permit-c ec all t appy:
OHVAC E]Gas Tank []Gas in Pip g Shutters_ Windows/Doors 9 �
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: So. Ft.of First Floor:
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Cost of Construction:$ Utilities: Sewer[]Septic !Building Height:
:OWNER/LESSEE: CONTRACTOR N
Name k4e,.,4,*,9 /'r'i-e.y, Name: _APY)I
Address: 13 l3 /,5- Pa rA1.,,.4d Company: I Z,f
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City: F-� _ R of ci_ State: t- Address: /Sl/7 5&/
Zip Code: 3 Fax: City: 5+.' Lc.,c;-'e State:)0 C
Phone No. Zip Code: 3 Fax: L//4
E-Mail: Phone No. 7 7Z - 37U; 8A 9 g§
Fill in fee simple Title Holder on next page(if different E-Mail:Adcnc r",./� ye, h o�.
from the Owner listed above) State or County License:'/'_Z k5�/,3
I[Lalueof construction is$250D or more,a RECORDED Notice of Commencement is required. !
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: : X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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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 Count 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 Notice of Commencement must be recorded acid 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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_Signat a of Owner/Lessee/Agent Signatur of Contractor/LicensetaialdV
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 2T LUcjes COUNTY OF �1 4 a6 k
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 21 day of A Q&i)51" . 2046—,by this�day of_ A 0601's T .20 .L by
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(Name cknowledging) (Name of p,rsort-a knowiedging)
igna oto Iic-State of Flor da) (Signature Public-State of Florida)
Personally Known _OR Produced Identification Personally Known�_OR Produced Identification
Type of Identification i?rQd Type of Identification Produced'
PATRICIA HERLEHY
Commission No.. Notary Public(SBI of Florida issio No. ,�����•��., PI 1814 HERLEHY
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•=My Comm.Expires Sep 21,2018 r°. .`�: Notary Public-State of Florida
'• :• M Comm.Expires Se 21,2018
1111,110 Bonded Through Naiional Notary Assn, commission 8 FF 129908
Revised 07/ %�e°F°`�'
�m„u��` BoMed Through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION i SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ! REVIEW REVIEW
DATE
COMPLETE
INITIALS