HomeMy WebLinkAboutBuilding Permit Application ALL APP L ALE INFO ST E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
PROP'OSED IMPROVEMENT LOCATION _
Address: (o o G,2 e is 'rte t q L
Legal Description: -11i e_I
�C,/-To / /2,cn z5 0 — os�3 co s l 5'o r — Zane-
Property Tax ID#: ' y DS - 80 O p -- 7— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIPTION OF WORK _
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CONSTRUCTION"INFORMATION..
Additional work toa er orme under this permit-check a appy:
HVAC 11 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
OElectric 0 Plumbing Sprinklers 1:1 Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Il ��� Utilities: Sewer E]Septic Building Height:
m coNTRACTOR:.
OVNNER/LESSEE
Name Name:_Csla eti er)- h p,t, ..
Address:Z(o f:CI 6+a-e. Company: C/1 i1
City: 'foz-f ?•e 17_1 1 State: Address:c�YA— _-5a 'Dy� lrP
v
Zip Code:-3 CL K X-�( Fax: City: -r-)_5C_ Stater
Phone No.-7 ,:J- - TC r /-Z 7 D Zip Code: 3 Lf c/�� Fax:
E-Mail: Phone No. - 'OL63-(5,76 3
Fill in fee simple Title Holder on next page(if different E-Mail: C K7-(L ry, 1
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL.�tCONSTRUCTION LIEN LAW INF,QRMATIONzk ti
r, �J '°• � r.��,�P� �
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:
Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 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 review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree 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,
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 our property.A Notice of Commencement must be recorded and posted on the jobsite
before the firIf you intend to obtain financing, consul I r or an attorney before
commenci or rec ding your Notice of Commencement.
S
MNTYOF .
a of Owner Lessee/Con or as Agen Owner ature o ontractor/License Holder
OF FLORIDA -' TE OF FLORIDA
_ COUNTY OF _'2 �-�
Th going instr nt was cknowledg efore me The fo oing instr ent was acknowledged before me
thiday of ' 20 y this lay of 2¢f JG by
ac(_pA
(Name of person cknowfedging) (Name of person ac nowledg g)
(Signature of NotaYy Public-State of Florida) (Signature of Nota - e
o4�arn , ANGELA M HUFF
Personall ngkv O E!� ► tion Personally Known '�: I? t r Pu 1iM247'03
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Type of I rr ,Ptg� Type of Identificati ri
;4 •:• Commission#FF 234730 ,',;�o���o?.�' fulu
Bonded throng alio I Notary Assn
Commiss rt `.�:� M Comm.Expires May($(�E0919 Commission No.
Bonded through National Notary Assn.`
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS