HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECER"7D SEP 2 6 7 36
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 1M`P;B VEMENT,
LOCIATIIOU
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Address: fffl- Eir,i
Legal Description: 0 14) c17 ,3 6 _2/u
Property Tax ID#: 000 Lot No. c27 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
6
-DETAILED DESCRIPTION N
OFWORK
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CONSTRUCTIMINFORMATIQW,
—Additional war to be Dertormed under this permit—check all Fat apply:
11HVAC F]Gas Tank FGas Piping Shutters ❑Windows/Doors
TsElectric 0 Plumbing E]Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S -t of First Floor:
Cost of Construction:$ Ord Utilities: SewerF]Septic Building Height-
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NTRACTOR
Name le,U In CL Name:
Address: YO 61 A1114tis Co mpang: r-_ C__
City: Fit e-;c,-, State:', Address: �9JCji�
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Zip Code:_ql-1 4q�i� Fax: Citv: k]Ero State,
Phone No. ,?, 3'-1'7 Z 9-91 Zip Code:
Fax: C;- -7 7
E-Mail: Ph 3ne No.
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Fill in fee simple Title Holder on next page if different E- all:
from the owner listed above) St z to or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Com nencement is required.
'SUPPLEMENTALCONSTRUCTION LIEN LAW INFOR MAT!.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Adidress:
City: State: Cit' : State:
Zip: Phone: Zi Phone-
FEE SIMPLE TITLEHOLDER: „Not Applicable B NDING COMPANY: —Not Applicable
Name: Na e•
Address: Ad ress:
City: Ci
Zip: Phone: Zip Phone:
I certify that no work or installation has commenced prior to the issuance of a permit,
St.Lucie County makes no representation that is granting a permit will uthorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and revie your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby a ree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and t.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen room and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Co mencement may result in your paying twice for
improvements to your property.A Notice of Commenceme t must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORIDA STA E OF FLORIDA
COUNTY OF �7 c COU TY OF -6 >�•'���41.,The forgoing instru ent as acknowledged before me The f r$oing instrument was acknowledged before me
thisck�o day of t 20�by this 6day of S�* k* 20` by
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(Name of person acknowledging) (Nam of person acknowledging)
{Signature of Notary P lic-State of Florida} (Sign ture of Notary P ic-State of Florida) 1\1.
Personally Known OR Produced Identification ally Known OR Pr r 42�
Type of identification Produced E- I 5 ype erso If Identification Prod a0�0
MAI--CQkatn b1le� ev
Commission No.m�`� i�O _tg510N 6,2v ission No.
�+ GO pecetn 1lnd ?� •�: gond
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07/15/2014
Revised T80F rp
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10 REVIEWS FRONT ZONING SUPERVISOR PLAS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE REVIEW REVIEW REVIEW
DATE
COMPLETE
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