HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
i'
Permit Number:
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 fi —
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: 1�1N
Property Tax ID #: `3Va2 Lot No.—
Site Plan Name: relm �'^'� 'j� _ Block No.
Project Name: "
Setbacks Front !�b- Back: .� Right Side: Left Side: Y Ea
DETAILED
DESCRIPTION OF WORK:
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awoy� -zo Lr 1 CS
IUltlonal worKto b(eertormea
HVAC I Gas Tank
unaertnis permit — cnecic all
E]Gas Piping
apply:
Shutters
Windows/Doors
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Company: U'~ -� k '� ��2-f
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❑ Electric ❑ Plumbing
❑ Sprinklers
❑ Generator
F]Roof
Total Sq. Ft of Construction:
Cost of Construction: $ Za�'
S,. Ft. of First Floor: _
Utilities: Sewer 0 5eptic
Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name izeve
Address: So b (.yrrle_ r✓F.
Name: ,cke-ei 1J4i-ot�✓`-
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Company: U'~ -� k '� ��2-f
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City: FY atrcX State: Pe-
Zip Code: `✓ Fax:_
Phone No.
Address:
City:
Zip Codq:._� Tgt ,�_?) Fax:
Phone No. 'K2-- ("76-2--3f?
State: —
E -Mail:
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Fill in fee simple Titl $ r`�n nextV" Qigl blifftEnt
-'` #FF044924
COM NSSION
from the Owner list = j
.EOF Fro, FYPFRES Airt�ii;;t 12. 2017
E-Mail:+�--
State or County Licen
:•°qg_ fi9:
If value of constructio s ii Commencement is requir d -
EXPIRES Augo-t 12, 2017
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: . Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City: �,+ .._
Zip: Phone:
City:
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
commencing work or recording our Notice of Commencement.
_,_, Signature of Owner/ Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDSTATE OF FLORIDA
COUNTY OF I.r _ COUNTY OF _ V
The for oing instrument was acknowledged 1pefore me
this for
of c5c- f 20 Eby
(Name of person acknowledging )
ll
(Signature of Notary Public- State of Florida )
Personally Known
Type of Identification
Commission N
Revised 07/15/201
OR Produced Identification
The forgoing instrument was acknowledged before me
this day of O'C-t . 20 2_�L by
plc ,
(Name of person ackn
(Sign
Personally Known
Type of IdentifigM
ARI KATZ
( Commsion No '.
MY COMMISSION #FFG44924
39(i-Uli 1irsc �l:�,urtvit�.cbiYf
ry Public- State of Florida )
OR Produced Identification
KIRK ARI KATZ
EXPIRES August 12, 2017
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS