HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `-\ Permit Number:
m R E C E I'.' D S LP 3 01.06
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
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PROPOSED IMPROVEMENT"LOCATION: .',,,
Address: 1116 SGAFbo cu \ri Ci-
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-Legal Description: �� f✓ R�)C,r-e�'� Y! �� s
Property Tax ID#: 33aa `507 _0008 `IW_O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DRIPTION OF W
ESCORK
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CONSTRUCTION INFORMATION:
Additional work toa er orme under this permit—c ec a t apply:
HVAC 11 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric FM
12==rPlumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ r Utilities: Sewer Septic Building Height:
OWNER/LESSEE: v. CONTRACTOR:
Name Name: V� ll V10(�
Address: �r\-N Zq `tea` Company: (T �oG
City: _� Of)i OmI . N( State:Al Address: rolaZq AW h
Zip Code: L5 S) �O Fax: City:
City: S� e State: �--
Phone No. 30/ - 3 - 1929 Zip Code: �)LIW G Fax:
E-Mail: Phone No. `
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Ad d ress:
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 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 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
commencj,ng work or recording our Notice of Commencement.
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_Signatur of own6/er/Lessee/Agent Signature of CoKctor nse Holder
STATE OF FLORIDAs4 STATE OF FLORIDAk
COUNTYOF / p 4LA 1, COUNTYOF L4
The forgoing instrumentwas acknowledged before me The forgoing instrument was acknowledged before me
this 150day of btAo, 20 L&by this 30day of b 20 1,6 by
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(Name ofr66n acknowledging) (Name o erson acknowledgin
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(Signature
(Signature of ary Public-State of Florida) Signature of of ry Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commissi , '+yti-•
n "NArMM8&yMONpF1 IGK CommisjNPATHAN RAYMOND
RIPYpAT 1 )
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•'e MY COMMISSION#FF233682 ''e MY COMMISSION#FF233682
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS