HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION ro BE ACCEPTED
Date: -Omv Permit Number:
RECEI�'rD S� 2 0 7616
Building Permit pplication
Planning and Development Services
Building and Code Regulation Division
2300 Virginial Avenue,Fort Pierce FL 34982
Phone: (7721)462-1553 Fax:(772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION l'
Address: „Z 7 7 WCI
Legal Description: 1w, 6 rcknDi S
Property Tax ID#: I Lj 10 (91 obo- O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Fi ont Back: Right Side: Left Side:
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DETAILED DESCRIPTION OFWORI< `
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CONST RUCTION INFORMATION:
Additionalwork to nGasTank
orme un er t is permit-c ec a appy:HVAC ❑Gas Piping Shutters ❑Windows/Doors
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L,WElectric 0 Plumbing _Generator Roof Roof pitch
Total Sq.Ft of Construction: S t.of First Floor:
Cost of Construction:$ Utilities: Sewer OSeptic Building Height:
OWNER/LESSEE C NTRACTOR
Name •
Nae: /117)
Address: 7 te W✓ n� Co pany: cz C�- r�:" C
City: =4- State: j Ad ress: 73I CG,.rri
Zip Code: Ci L�` Fax: Ciy��)_ ,�) Stater
Phone No.—/- b "5S- 7 X Zi Code: 3P-67N &8� Fax:_09"Cl-7 7 57
E-Mail: Ph ne No. 11 -
Fill in fee simple Title Holder on next page(if different E- ail: ��Y +_cl�-i c _ lruti� rA29►.t^
from the Owner listed above) St to or County License:
If value of construction is$2500 or more,a RECORDED Notice of Com nencernent is required.
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SUPPLEMENTAU', O tTRUCTION:LIENt'Ir4W INFOR:' ATIO;N
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Na e:
Address: I Address:
City: I State: Cit State:
Zip: Phone: Zip Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BO MDING COMPANY: Not Applicable
Name: I Na e:
Address: I Adc ress:
City: I c;
Zip: I Phone: Zip Phone:
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certify that no work or installation has commenced prior to the issuan a 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 ag ee 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,
accessorystructures,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 Commencement may result in your paying twice for
improvements to your property.A Notice of Commencerner 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 0 ner ssee/Contractor as Agent for OwnerSigna ure of Contractor License Holder
STATE OF FLORIDA STA E OF FLORIDA
COUNTY OF ��. �V c l COUNTY OF
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The fo�oing instrument was acknowledged before me The forgoing instrument w s acknowledged before me
this day of p� 20�by this qday of 20 Eby
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi State of Florida) (Sign 3ture of Notary lic-State of Florida)
Personally Known OR Pro ced Identification ally Known OR Pr uce I BENS
Type of Identification Produced t- Z- $Type Identification Produced C-
Commission No (Se �p,M pNpQ� on No.
Revised 07/15/2014 g '.9= eoz
REVIEWS FRONT Z G SUPERVISOR PLA S VEGETATION SEATURTLE MANGROVE
DATE UNTER
COREVIEW REVIEW REVIE REVIEW REVIEW REVIEW
COMPLETE
INITIALS
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