HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I `�
Date: c (,g J (P Permit Number: f ��• V �� .
RECEIVED HP 2 00 7.016
Building Perrhit 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 IMPROVEMENT".LOCATION: ,.
Address:
Legal Description: �
Property Tax ID#: ! �d -.. 7 cJ�'� t�� �r2 �(e) - L/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESC'RIPTION OF'-- ORK
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s 4VAe� j+wys S L 0 ick,�1 O�
,CONSTRUCTIOfVINFORMATIO . z
Additionalworkto e e orme uN:,n er this permit-check a appy:
RIVectric
AC []Gas Tank DGas Piping Shutters F]Windows/Doors
0 Plumbing Sprinklers Generator El Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
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Cost of Construction:$ Utilities:0Sewer OSeptic Building Height:
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OWNER/LESSEE ; CO'NTRACTOR
Name : -1 C k Name: lou,J y
Address: n C4 G P! etz,ck Company: C-4 �^ ( L
City: Ft- I tAc•, State:�'� Address: ��( ��✓�i��L, !� �:� fi,/�
Zip Code: ?�-(C'f5 Fax: City 1/ -State:_Ell �
Phone No. ZipCode: 2�iG� Fax: S��-CIT7s
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: Cs CA 'C EYCC. ( co^
from the Owner listed above) Statll or County License: i5_660012 ci
If value of construction is$2500 or more,a RECORDED Notice of Comm' ncement is required.
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SUpP'L€IVIENTAL'CONSTRUCTlON LIEN�VLAW iNFORIUTATIQN t
DESIGNER/ENGINEER: Not Applicable M?RTGAGE COMPANY: _Not Applicable
Name: Nime:
Address: Address
City: State: Cit • State:
Zip: Phone: Zi I: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
Zip: Phone: Zip. Phone:
I certify that no work or installation has commenced prior to the issuar a 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 revieyour deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby ag ee that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and�t.Lucie County Amendments.
The following building permit applications are exempt from undergoing is full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen room and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Cc i encement may result in your paying twice for
improvements to your property.A Notice of Commenceme t 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 ontra or as Agent for Owner Signa�ure of Contractor/License Holder
STATE OF FCO IDA STATE OF FLOFjIDA
COUNTY OF COU TY OF �'Y" t_..t C %Q-1e before me The fdrgoing instrument was acknowledged before me
The forgoing instrument was acknowledged
this-411 day of e S C' 20 k5 by this�day of Isz.::e ,20 _ by
(Name of person acknowledging) (Name of person acknowledging)
l�lJ
(Signature of Notary Pub' -State of Florida) (Signature of Notary Fu is-State of Florida)
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Personally Known OR Produced Identification Personally Known OR Produced �p_23�
Type of identification Produced 2. L ype df Identification Produced
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Commission No. b �"'otiIQ� ' t mission No. s>G \ c�Q
v' 4 c;' ';\'o g 1AI .._ 9nde
Revised 07/15/2014 V
REVIEWS FRONT 7SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER (EW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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