HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB E INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZO Permit Number: I l q- n
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 VP
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Address: 7_-_�06 &b _0` Leh n
Legal Description: y�
Property Tax ID#: 33 ZZ- S O S ' 0 oco I — O00-- 3 Lot No.
Site Plan Name: IIS u Irl C((-)yi Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTION iNFO�R,l1%IATI`ON11 n{ )Tr ' �, ,u� t` _
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Additional workkto bene ormev under this permit—check all jn'ah�:
HVAC U ❑ ping Gas Tank Gas Pi S❑ utters ❑Windows/Doors
Electric 0 Plumbing []Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Constructioon:a S Ft.of First Floor:
Cost of Construction: $ "/,9�9 . 40 Utilities:Sewer EI septic Building Height:
OWNf,R/LESSEE y i
Na x ,pR s t
".T:-t•<C
Name &51AOC i6YI ( Name: eVe_
Address: 7500 (' U 0sCompany: Life7lNn:e ��'}"E'r�orS �nc-
City: �P0Y_1_ 010 1/W e_ State: Address: la 2-
Zip
Zip Code:39 q E3& Fax: City: Lza g-40— WOY 1 State:F1
Phone N �)Z) y Z9— I ZZ j Zip Code: 3-'=1 & 0 Fax:
E-Mail: Phone No. �5 5 g 7 41.3Z
Fill in fee simple Title Holder on next page(if different E-Mail: /Gr N l ���C er1' �dYr• +
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S:U;P:P;LE_MENTAL CO;NSTR',UCiF119fl L1,§ 6,A'N I'NI;A= R ' ASI
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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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO v DD STATE OF FLO Luh
COUNTY OF �� + LUCI C COUNTY OF JC.IC_
The forgoing instr ent w s acknowledge before me The forgoing instr exit as acknowledged�before me
this_Wday of 20 acknowledged
thisaQ day of 20 [ by
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(N a of person ackno dging) (Name person acknowled )
(Signature of Notary Public-State of Florida) (Signature of Notary
Public-S of Florida
ntiff )
Personally Known OR Produced Ideicatio Personally Known XC OR Produced Iden
Type of Identific d Type of Identification Produced
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Revised 07/1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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