HomeMy WebLinkAboutBuilding Permit Application I
ALL 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
2300 Virginia Avenue,Fort Pierce FL 34982
;2: (772)462-1553 Fax:(772)462-1578 Commercial Residential. t,/
PERMIT APPLICATION FOR: To Select from drelh^Y,. crf-k,rmui ?++hm anof line
PROPOSED IMPROVEMENT LOCATION:
Address �s -I-all r'66 If'' i%') "- 1-i
Legal Description:
Property Tax ID#:�?3�� a f' wg� S cncoS` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
l uuc�u�e ��(�r�s �'f•. 1�5 tet- �u5-fca-fit •3"tlq�-e r ra--V-7 4ss r-e-."r,.loa
r-""'STRLICTION INFORMATION:
.. j
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Additionalwork to be nerformed under t ispermit-check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windo�ms/n--rz
11 Electric 0 Plumbing Sprinklers I Generator l e Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ -7,Oe I. OeD Utilities"
_Sewer 1-1 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name rlp-le ,400 P,- a _
����_ Name:�1�(l r,�A.� S !Ota(z' /��
Address: f�9 '-5 ' uq 9--ege3� �-t". Company: C'o�c 1�� f�� 1�� ,,zGciv,_ u_G
City: roe '" P(&-019 State:V Address: d63 4q t b W 25C
Zip Code: `341?c74,S_ Fax: City: l State:
Phone No. _>7 Z, 46 1 /Wee Zip Code: 3 Fax: '
E-Mail: Phone No. -77 370 -- 3�
r:s-lifferent E-Mail:4,u,. l C- , 7-77T
�L �1J1
from the Owner listed above) State or County License: 0._ 06 or.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: _-
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone:. Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Add ress:
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 grantine a permit will suthnri7P the nPrmit hnidPr to hidid the�i ihiPrt ttrnirture
which is in conflict wit" _.'_"
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,
arrPccnn,stn art,ices c..,immina nnnlc fences !+,allc cianc screen rnnmc and arreccnr��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.
J
Signature of Owner/Lessee/Con ctor as Agent for Owner Signature of C tractor/License Ivoller
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S LUCOUNTY OF 67-. f ae-/6:'
The forgoing 1nstr�ryi ent was acknowledged before me The forgoing instru nt was a knowledged before me
this9cl dayof�l/ovPh1hOr , 20/&by thiso?9 dayof Q 20/J,-by
1
(Name of person acknowledging)' (Name of person acknowledging,)
(Signature of,r@tary Public-State of Florida) (Signa ure oftary Public-State of Florida
I )
Personally Known OR Produced Identification Personally Known ' OR Produced Identification
Type of Identification Produced Type of Identification Produced NANGY
Pu"28,7201
S
Commission NoNANWAOSE BRM Commission No �oZSd 0•? ICOmNo Public,State of Florida Explrer
28,2017
Revised 07/15/20 ,P;H��� e
_EI July
Ht► Public uta«ww"M
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS