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HomeMy WebLinkAboutBuilding Permit Application„LL At rL11_AtsLk INF© MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application Planning and Development services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34952 Phone: (772) 462-1553 Fax: (772) 452-1578 Commercial Residential ' PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: L4 Legal Description`'L.: Property Tax ID 4: Site Plan Name: Project Name: Setbacks Front Back: DETAILED DESCRIPTION OF WORK - Right Side: Left Side: 1 Lot No. Block No, CONSTRUCTION INFORMATION: A Ntrona worR 10 [e` er orme un er t is permit- check a[1apply: �iiVAC j =J Gas Tank Gas PipingShutters a Windows/Doors _ 1=l Electric 19 -Plumbing O5prinklers Generator Roof Tota{ Sq- Ft ai Construrtbn- Cast of Construction: $ S 0 &” 5q. Ft. of First Ffoor_ _ Utilities: 0Sewer ❑Septic Building Height- OWNER/LESSEE: CONTRACTOR: Name �f N` at '`� €0 Name: Z7 D its F Address: .. Company: G 4 UM6 tt.5 �. City: State: l Address: Zip Code::,`��-f, Fax: City: b Uaf_ State: 1=L - Phone No. Zip Code: 3qq52 _ Fax: 7? 33SP ai80 E -Mail: Phone No. 7' - 397-- 3(_'s - Fill in fee simple Title Holder on next page ( if different E -Mail: ¢►�5is {`�Lui�,b�t1 rt��c�c } ' L CSM from the Owner listed above) State or County License: 2 If value of construction is $7-500 or more, a RECORDED Nlfotice of Commencement is required. 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: City - Zip: Phone: Zip: Phone: I certify that no work or installation has commenced prior to the issuance of a permit_ 5t. 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 w0i, 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 recordin.R your Notice of Commencement. ture Tactor as Agent for Owner Contractor/Lice STATE OF FL A STATE OF FL DA COUNTY OF f COUNTY OF The fprgoing rostrum nt as ac cnowledge before me The forgoing instru ent was acknowledged before me this day of 20 ��Qby this � day of PC 20 / by (Mame of person acknowledging ) (Name of person a knowledging ) (Signa re of Notary Public- ate of Florida } (Signat re of Notary��Procluced ate of Florida ) Personally Known ld OR Produced Identification Personally Known Identification Type of Identification Produce Type of Identification Produced y " ' C . MARIAN MILLS S `. ssion#FF0237fi3 Commission No. = 5 � "r F023.63 �r Commission Na. _ :"_ - ( e 3, 2oi ( Exp�iresJune3,20t7 : %r` ,- K^:.es., n f,. -'F .•- [r.,Fair:•: r ,;,. 6qidedThrdTm Fa�losaFio�e9003857C1� i ,� � �;,.—'—'=� Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS