HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 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 f/
PERMIT APPLICATION FOR:: .To Select from dropbox, click arrow at the ehd of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#:. � o —/q/ _000-
000"'Q Lot No.
Site Plan Name. 6(-j Block No.
Project Name: k
Setbacks . Front Back: Right Side: : Left Side:. ..
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit—check all appy:
HVAC Gas Tank: Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers 1 Generator ❑ Roof Roof pitch
.Total Sq. Ft of Construction: 2W S . Ft. f First Floor:
Cost of Construction:$ . Utilities: L"J Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
on
Name n -V '_W Name: T1-7 n A0 SCC .
Address: ' �t U
l— e our Company: /Pleb
City:_alat�` State: Address: 37,37 AI M S
Zip Code: 4 01 Fax. City: L,c>60C+ State: -�
Phone No. - a�Z � Zip Code: 0 2 1 Z� Fax: 3e1-63'65775;41
E-Mail: Phone No. SSGS
Fill in fee simple Title Holder on next page(if different E-Mail: _ kci sk. .o69 t
from the Owner listed above) State or County License: 5
2. 9
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. �����
SUPPLEMENTAL CONSTRUCT19XLIEN LAW INFORMATION:'
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 your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. IfWu intend topbtain financing,consult with lender or an attorney before
commencing work or recdVg ypur NoYj(e of Commencement.
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Signature of Owner/Lesse.1 n t MOM as q9n 3–MeT QIn
Signature of tractolr/ ens older
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STATE OF FLORID4-4STA FLO
COUNTY OUNTYOF T=>t1C_111
The ifor in instrument was acknowledged before me The forgoinLinstrument was acknowledged before me
I gi g of ,I c.,:., 201,S.by th0!>X!*a�y7of 20 1k by
this
r1*4 VA 0=421- V—;P-4
Name erson acknowledging) (Name of person acknowledging)
(S5iignatu of Notary Public- ate f Florida)
(Signature of NotarVKublic-State of Florida))
Personally�K OR Produced Identification ersona OR Produced Identification
T tifi t.
dentificatfion Produced Ty f Id tification Produced
Commission No. (Seal) Commission No- (Seal)
1pRY Pry
JACKIE FORSYTHJACKS FORSYTH
=A is;ON#FF 158alS M_T_WMAI rr 10410
EXOrA *
PIRES: ober 15,2018 F, *
, EXPIRES:October 15,2018
Revised 07/15/2014 OFF
6O.Tdod 1h.-duaget Notary services
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS