HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �(����-I-'�`(�z_ Permit Number: \06- O n i
1. 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 IMPROVEMENT LOCATION:
Address: > Oe)Lsn-64
Legal Description:
Property Tax ID#: nt `�a3� `��°� ' d aCl " ��� ' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�j
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC E]Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
BO
Cost of Construction:$ � Utilities: _Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameCA Name:
Address: aj Companylohn eo er t rebo, Pa+ rid
City: AFf?"-e- State Address:
Zip Code:��'yq�� Fax: City: State:
Phone No(�' L�- lako ' 13�g_5 Zip Code: ^^ Fax: /�
E-Mail: µ Phone No. !
f
Fill in fee simple Title Holder on next page(if different E-Mail: Cc nor-
from
the Owner listed above) State or County L se:
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: Address:
City: State: City: Stater
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 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
commenciri ,work or recor1dingYour Notice of Commencemen
s
Signature 9f.Owner/Lessee/Contractor as Agent for Owner Sigp6ture.of Contractor/License Holder
STATE OF FLORID STATE OPFLORIDA 7 1
COUNTY OF �JI.LC�� COUNTY OF fit-"- ( L�
The f rgoing instr,4 hent w s acknowledggg" before me The for oing instr} met,was acknowledged before me.
this ay of (J� 20` by this ay of �`-"u �✓ ,20 ( by
(Name of person acknowledging) (Name of person acknowledging)
r
(Signature of Notary.Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally.Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.a (seal) �C � Commission No. (Seal
NOTARY PUBLIC Me T 0 ROF
PUBUG
C 81u�dlbd
STATE OF FLOIRIVA
Revised 07/15/2014 rx'n' o48B4 STATE ���
44 WrExpires 8J1412020 Cann c�oo4e�+
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS