HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: `� aC'P Permit Number:�(o 0�^ 1
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• RECEIVED SEP 2 7.0�6
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 V10
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line IJ-1
PROPOSED,IMPrROUEMENT I:OCATION ,
P
ry
Address: q,1 e,
Legal Description: 0
Property Tax ID#: �i� " 0 'd�Q Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'OF WORK
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9C-VMe LC)G44nA
CONSTRUCTION INFORMATION: ,
Additional workto e e orme under this permit—check a appy:
HVAC 11 Gas Tank ❑Gas PipingOGenerator
Shutters ❑Windows/Doors
t—aElectric El Plumbing Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: Scl.Ft.of First Floor:
Cost of Construction:$ ��� Utilities: Sewer Septic Building Height:
'OWNER/LESS,EE CONTRACTOR
Name ,SO/) Name:
Address: re' JliCompany: /S-
City: i'.✓ State''/ Address: 7,31 LtcPP--/trr�(C, `,G„l1Pi �ir/tn y
Zip Code:2Lfq'/5 Fax: City: ue'o /�cl'7 State:
Phone No. _— �Gj ��%,Z Zip Code: Fax: �05—577!�—
E-Mail: Phone Noor� Y2
Fill in fee simple Title Holder on next page(if different E-Mai1: + CV>-c c.
from the Owner listed above) State or County License: GQ(D ?��
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. .(
S,UPPILEMENTALCONSTRUeCTION LIEN LAW'INFORIVIATIQ;N
DESIGNER/ENGINEER Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 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 l 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.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor License Halder
STATE OF FLORDA STATE OF FLORA
` 4 U cST, ���•�
COUNTY OF , L %'9' COUNTY OF
The forgoing instrument was acknowledged�before me The forgoing instrument was acknowledged before me
thisata day of Slk& 20 l`Oby this QJG day of 20 `; by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P Iic-State of Florida) (Signature of Notary Phc-Sta�ofrida)
i"
Personally Known OR Prod ced fit#"' Personally Known OR Pro ced Ide
Type of Identification Produced u2Type of identification Produce 3
D \551 15, secs �* Cfl 1SStflN 1s,2020
Commission No. . �M'lflfl �p'Jb undeNn' Commission No. "�� 7P�' Q,T. .p'CUndeWPI 1
~• Boz �Pa�Not�Y '�T, ..oaq gonded�uN
Revised 07!15/20 o,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS