HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLIC BLE INFOr 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
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: j}
Address: e7
Legal Descri tion: �n �{lif. u )���� + dill fo
(liar (. i fel l�,�!.�
Property Tax ID #: L f '� oL— U) r rT
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side
DETAILED DESCRIPTION OF WORK:
(al
Left Side:
Lot No,
Block No.
CONSTRUCTION INFORMATION:
Additional work to he ertormed under Wis permit —check all apply:
HVAC Gas Tank ]Gas Piping _ Shutters Windows/Doors
ElElectric PlumbingSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:�� S Ft. of First Floor:
#ilities: Sewer Septic Building Height:
Cost of Construction: $14 4
OWNE
R
/LESSEE: r
Name J IVI�/A`Ytty
Address: it GcxL C_Xt/ _
City: ()-{ � f l d State:
Zip Code: . Fax:
Phone No. 46r 0% t ''1 UC, • ss sS
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
I CONTRACTOR:
Name: C .FN-�
Company: 7 1 lJ
�r
Address:
City. 1/ I im) State:
Zip Code:77��� Fax:-`Y-rT
Phone
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E-Mail:icn_�4!-(.�Li a�--RVIi l�VV�L.�SG
State or County License: C 1� to V iy
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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 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. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
s
_ Signature of Owner/ LWAget4r Signature of ContractorJLicens older
STATE OF FLORI A STATE OF CO NTY OF O A
COUNTY OF
The for oing Inst ment was acknowledge before me
this day of + 20 �sby
q�r-�Vaa � 7� C-) t�1
(Name of person acknowledging )
(Signa re of -otary Public - St e of Florida )
Personally Known ' — OR Produced Identification
Type of Identification Produced
The forgoing ins'ument was acknowledged before me
this day of I )p I.O.VIA t�tN , 20 L by
(Name of person acknowledging )
(Signat a of otary Public- tate of Florida )
Personally Known `-r OR Produced Identification
Type of Identification Produced
Commission Noll•+-: ... fission NoTVVson)::'..f sr
s; ..s
JOYCE MICHAU - ;�sE�•,4 JOYCEMiCHAUD
*. MY COMMISSION # FFty ' MY COMMISSION # FFC
��` Bonded Thru Notary f aBlp UnUor n lets , �I Rf 0.t Bonded Thru IdoLary F�nktit U2018 -
ndorar��t
Revised 07/15/2014 - -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE _
INITIALS