HomeMy WebLinkAboutBuilding Permit Application ALLUPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (CDCR �
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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEp IMPROVEMEIINl" LOCATIOtN
Address: 1260
Legal Description:
Property Tax ID#: L{' _763--00 39 —00b`7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:x Left Side:
DETAILED DESCRIPTION OFWORK f �
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CONSTRUCTION INFORMATIONj.
Additional work toe e orme under this permit—check fa appy:
HVAC []Gas Tank OGas Piping _Shutters l.__L Windows/Doors
OElectric 19"Plumbing OSprinklers O Generator Roof Roof pitch
Total Sq. Ft of Construction:
Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/LESSEES ' .CONTRACTOR
Name GLV[&S GtZG�' Name: evi k ✓� �l/
Address:
L abb O_V- - CIVC B 1 v Company: Forte . �ji Cw-nvL
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City: . p(ey-a_ State:=L' Address: A79! e_&V1A2r C-
Zip Code: 3Wq7— Fax: City: l e re__zState:�Ci
Phone No. 3�� Zip Code: _73+'? 1Zy- Fax: "C —�ObV,
E-Mail: Phone No. (11 —66 L
Fill in fee simple Title Holder on next page(if different E-Mail: 'I,t1r u ( L✓1 ®' �SdLt ).
from the Owner listed above) State or County License: �0 57ag
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUf�QLEMENTALCO`NSTRUCTION LIEN LAWY�INFRMATION
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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 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 our Notice of Commencement.
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Si at re o O n Le see Co tra or as Agent for Owner Signatu a of Co acto is nse Holder
STATE OF FLO A STATE OF FLO
COUNTY OF ��- .(J h 1 COUNTY OF l-lLC-L-�
The forgoing instrument was acknowledged before me The fo%oing instrument was acknowledged before me
this 15' day of D�P wrbf tx 20 Lby this IL day of e✓20 1 Zby
AfZL6me, 21GSf5y &t exle Pu(o5/3Y
(Name of person acknowledging) (Name of person acknowledging)
Alltuz��� L4& -
Signature of Notary Pub -S61e of Florida) (Signature of Notary Public-Stde of rida)
Personally Known u OR Produced Identification Personally Known �/— OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.rF NER1 88
0L 766/ ...."., eal) ARLENERIGSBY mmission No. F r Q t97 ; ;''`. e�l)COMMSSION#F 027661
v. S MY COMMISSION 1k FF 027661 'XPIRES;June 13,2017
o EXPIRES:June 13,2017 �_`�,f;' Pon;�;Tnv
_ Nota Publc
P.n
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS