HomeMy WebLinkAboutBuilding Permit Application 'I
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _1/
Date: Permit Number:
Bull long Permit AppkaVgn
planning and Development Services j
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 j
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
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PERMITAPPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCA+T10IV:
Address:
Legal Description: by-t o.v �: 1�G11�- y C p-II— ['� Ca►' 3 t lA 2-- Z-b'L2�
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PropertyTax ID#: Lot No.�_
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Site Plan Name: _ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OFWORK: `!
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CONSTRUCTION INFORMATION:A ltiona wor to e e:orrne un er is ae'rrJari— e :.a n apply:
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HVAC Gas Tank Gas Piping Shutters Windows/Doors
LJ Electric Plumbing O Sprinklers Generator Roof Roof pitch
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Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ o�-7�y Utilities:o Sewer F Septic Building Height:
OWNER/LESSE}E: +`CONTRr 013
Name k �G✓ er Name:_ � i' o��
M C
fAddress: gL(aL( gr,��c(44-" TirLr'f-- Company: i
City: State: _ Address:
Zip Code: tO Fax: City:_ t� �'e State -
Phone No. -7 7a Zip Code: 29 q6Z I Fax:,7�-33rc-�/�G
E-Mail: Phone No-
Fill in fee simple Title Holder on next page(if different E-Mail:
from the owner listed above) State or County License: if'PG
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL-CONSTRUCTION LIEN LAW INFORMATION:
DESiGNERANGINEER: _Not Applicable MORTGAGE COMPANY: �Not Applicable
Name: Dame:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ _Not Applicable BONDING CO11iitPANY. —Not Applicable
Name: fume:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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. if you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement'
Si na re of wner/Lessee/Contractor as Agent for OwnerSignature o Contractor/Li e o der--°`
STATE OF FLORIDATATE OF FLO AI
COUNTY OF Mn rn 9 cr o, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this A2L'�day of 21�y.-� 20 i( by this�ay of�c�y ynt�s—.24 Rp by
(Nam ofowle(ging} (Name now a gi
(Signature o a ic-State of lorida) (Signature of Notary ,ublic-State of Florida}
Personally Known OR Produced Identi i ation Personally Kn n ! OR Produced Id tifica ion
Type of Identification Produced Type of Identification Produced
NOW
Commission No. .��i�'?y {Seal}HELEN DOWNING mm€ssion No. `"� lik, ��II�DOWNINQ
�. MY COMMISSION#FF 036576 :*; ;:a MY�q��SSION#FF 036576
EXPIRES;July 21,2017 .' EXPIRES:July 21,2017
Revised 07/15/2014 i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
JINITIALS