HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
' V
Building Permit Application SEP 1 G
Planning and Development Services 2016
Building and Code Regulation Division PERV1tTTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Luci C n FL
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PfOPpSED IMPROUEIUlENT LOCATION � 777 777
� _ -
Address: �. � �
q5g
Legal Description:"'
Property Tax ID#:, �,�`fl�- ( ��-(�� _� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Ba : Right Side: Left Side:
f 7
DETAILED DESCRIPTIzON"OF WQRK - _'� � ' ��
CQNSTRUCTION INFORMATION
_
AO(Jitional work tor
e e orme un er t is permit-check a apply:
Y=
HVAC "MGas Tank ❑Gas PipingShutters n Window
— 11 s/Doors
ectric 11 Plumbing Sprinklers 0_Generator D Roof Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ ���� Utilities:OSewer Septic Building Height:
'CONTRACTOR°
Name Name: K7, w� EV196 -1'M- .A
Add s: Company: CCugjY> LEC-rp,lt moi} rxvti
City: U. State: (— Address: 7 3 (9U l0 / PL
Zip Code: C Fax: City: )90k7` 97'4.uCl9 State: f2-
Phone N - _ Zip Code: 3'Y q59 Fax: _7U-9 -7/7(
E-Mail: - Phone No. 7 A-3710•-�7��
Fill in fee simple Ti Hol a on next page{if different E-Mail: D C 1�2 ,Jeff @ /Ili7"
from the Owner listed above) State or County License: F_CG003CY7a
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEIti/IENTA!C4NST�ZIIGTI�ON �.IEN L%�W IN�FORMAl'lON�3x
DESIGNER/ENGINEER: d2Not 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: _ of 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 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, consul with lender or an attorney before
commencing work or recording our Notice of Commencement.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contr for/License Holder
STATE OF FLORIDA �p / STATE OF FL IDA
COUNTY OF U. & COUNTY OF S,+
The f r in mstru nt N sack wled before me The f r oing instr
en was acknowledge before me
this day of 20 if this day of_ 20 by
(Name of r n ac nowle I.'• (Nam of s acknowledging)
(Signature of Notary Pu lic-Sta Flo
��s �� (Signature of Notary Pub f.•,rida�
Personally Known OR Produce n4f� ,nF` Personally Known OR p�luc 1 n
Type of Identification Produced F d Type of Identification Produced 'FA '�
c O ,
Commission No. (Seal) �i, ?o,�so�s Commission No.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS