HomeMy WebLinkAboutBuilding Permit Application ALL APPLICqLE INFO 7M/UST BE COMPLETED FOR APPLICATIO TO BE ACCEPTED jQ ' l ,
Date: �l t� Permit Number: ( � � / y�1 4`
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RECEP, SEP 2 6 2636
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982 i
Phone:(772)462-1553 Fax:(772)462-1578 Commerc al Residential
PERMIT APPLICATION FOR: To Select from dropbox click arrow at the end of lineC c
PROPOSED IMFRQVEMENT;LOCATION .I.
Address:
Legal Description: ✓1 E%
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Property Tax ID#: ! ` i Q Lot No. R
Site Plan Name: Block No.
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Project Name`:
Setbacks Front Back: Right Side: Left Side:
[DETA' ILED_WJ k
ON OF WQRK
CONSTRUCTION INFORMATION:
Additionalwor to e-N
e Orme under this permit–check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
_Electric i �Plumbing Sprinklers Generator ID Roof Roof pitch
Total Sq.Ft of'Construction: SQ.F .of First Floor:
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Cost of Construction:$ Sbo Utilities:
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[]Septic Building Height:
OW'N`ER/LESSEE CO TRACTOR': ,.
Name A Na e• L✓1
Address: 00Co parry: C� i,<.,
City: Stater Add ess y'k CL
Zip Code: 'IJ _ Fax: ! City �� C� Stater
Phone No.—1 � � 1 � Zip ode:C?tA 57 Farxl
E-Mail: Pho a Na.
Fill in fee simple Title Holder on next page(if different E-M il: C.G�C
from the owner listed above) Stat or County License:
If value of construction is$2500 or more,a RECORDED Notice of Comm ncement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW lNFOR ATfDN
DESIGNER/ENGIN , MORTGAGE
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NEER: Not Applicable M RTGAGE COMPANY: •_,_Not Applicable
Name: Nm :
Address: I A dres s:
City: l State: Ci y: State:
Zip: I Phone: Zi Phone:
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FEE SIMPLE�TITLE HOLDER: _Not Applicable B NDING COMPANY: Not Applicable
Name: Name:
Address: I Ad ress:
City: 1 cit
Zip: I Phone: Zi Phone:
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I certify that no work or installation has commenced prior to the issua ce of a permit.
St.Lucie CountI makes no representation that is granting a permit will uthorize 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 revi w your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby a ree 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 undergoin a full concurrency review:room additions,
accessory strucItures,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 Co mm
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
commencin work or recordingour Notice of Commence ent.
Signature o Owner essee/Contractor as Agent for Owner Sign ure of Contractor/License Holder
STATE OF FLI ,�tIDA STA E OF FLO%I3ALilcY�
COUNTY OF ' )r-1-Q1 c i� ST NTY OF #''
The forgoing instrument was acknowled qd,�efore me The f rgoing instrument was acknowledged before me
this'd day of Sz 20 j��by this day of� - 20 _* by
(Name of person acknowledging) (Nam of person acknowledging)
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(Signature of Notary Pu ' -State of Florida (Sign ture of Notary P c-State of Florida}
Personally Known OR Pr uced � � 2��Z APerso ally Known OR Produced dentification
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Type of Identification Produced 5. 1+pe f Identification Produced _t'
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Commission No, N? \ Com ission No. 0 fON ZO2 1'
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Revised 07/15/2014 """'� °� "•''f"`"�`
REVIEWS FRONT ZONING SUPERVISOR PLA5 VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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