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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2340 Virginia Avenue, Fort Pierce FL 3498.E 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: -5_5) �) 60 i-e OP- Legal Description: G!!Q` P Property Tax ID #: 500 ._ 0060 — X0 Lot No. J' Site Plan Name: Block No_ Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additional cl—tae performed under t is permit--chec all that appy: HVAC Gas Tank E]Gas Piping O Shutters F—] Windows/Doors Electric 1^ 1 Plumbing OSprinklers E Generator D Roof Roof pitch Total Sq. Ft of Construction: SFt. of First Floor: Cost of Construction: $ ,20 utilities:n Sewer D Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name 4�QoLf Name: GI J° '?06'� Address: '' ti� E l_' Company: .— City: E f eiyRe State: rL Address: > L We Zip Code: 'Jy 51 Fax: City: lit ' 3/ 11U LA State: G Phone No. '7'7,q L Zip Code: Fax: E-Mail: Phone No. _ �.� 77 - G2'Y Fill in fee simple Title Holder on next page (if different E-Mail: fr©m the Owner listed above) State or County License' L`'-_' If value of construction is $2500 or more, a RECORDED Notice 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: Address: BONDING COMPANY: Not Applicable Name: 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 Horne 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-Gr,recording your Notice of Commencement. _ Signature of as Agent for owner STATE OF FLORIDA/_ C COUNTY OF The far Ding ins tru�?n,wa acknowledged before me this day of % 1��i, �l�l Z 20 &by Goya I I OL' -1 (Name o�per�ian acknowled" ) re of Nbtapr{'' ublic- State of Florida ) Personally Known 'I OR Produced Identification Type of identification Produced Commission No_ Revised 47/15/2014 53 JOHAAMAN 4AYF O40 0I_ 0A1f*& MY COMMISSION # K¢233682 EXPIRES May 21, 2019 FW Jallo,.a,vSorvice.urc re of ContractorAicense Holder STATE OF FLORIDAc'1 elf COUNTY OF _V / �_ The forgoing instrument was of knowledged before me � I this ay of `t4- 11hcc 20 1,6 by _S�" il � Y'qro L-� (Name of geyson pcknoyvledging1fi of N(/ary PAlic- State of Personally Known X OR Produced Identification Type of Identification Produced Commission No. 53 llcl� 14AYMOND FITZPATruCK' My COMMISSION # FF23M82 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE - } — INITIALS }