HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE 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
PRQPOSED.I1111PR01lEMENT LOCAL ION
Address: Imoo S O�1V 0z4ye— /k OT 12_oL
Legal Description: Q A o N,00 N%T 0
/62 7777 �L
Property Tax ID#: -7 —b1 Z3 r G�3- Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: �Right Side: 4-Left Side: j�-
QETAILED DESCRIPTION OF WORK
E�
CONSTRUCTION INFORMATION r
Additional work toe e orme under this permit-check a appy:
❑HVAC E]Gas Tank FIGas Piping _Shutters ZWindows/Doors
❑Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
0
Cost of Construction:$ 121 S_ Utilities: _Sewer Septic Building Height:
QWNER/LESSEEx g CONTRACTOR ` Fes' kPx
Name Name. IeIC, 00094illAl
Address: Q!2QQ S cQG�� 120 Company: ""� W1,A1W4
City: ^�SagJ �b t.1-I- State: r- Address: /"I Al -& y_ c
Zip Code: 3y1 9 Fax: City: ��y/Al1� State: '', 4;
�T y
Phone No. Zip Code: 3Ky Fax: (�61Z-rr'7�y
E-Mail: Phone No. (a17--goq0
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:Car
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUC?PLEMENl'AL CONSTRUCTION L1N LAW INFC3i2MATtON x
h
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 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 failur to cord a Notice of Commencement may result in your paying twice for
improvements to your pr er . N Ice of Commencement must be r cord d d posted on the jobsite
before the ' st in ecti . I i nd to obtain financing, con le e o an attorney before
comme In or Deco I r Not Co nc me
s
S'gnatu of Owner/Lessee/Contractor s Agent fo Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_�37777 COUNTY OFs':;"7—
The forgoi instrument was acknowledged before me The forgooii�g instrument was acknowledged before me
thip? of ��` 20/�by thjs���"""c�ay of en= 20/�by
c&1,4
(Name of person acknowledging) (Name of person acknowledging)
(Signatu f-Notary Public-State of Florida) (Signatur Notary Public�State oTFlorida)
Personally Known L--'- OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. - -
r-
, ANN M.QAUMOND
3907
�IRES,
73907 s•• a EXPIRES:December 7,2018.
Revised 07/15/201 °• ,2018 Bonded 7hm Notary Public Undenvrders
�; '
'o?; Bderwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS