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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 't ` i�l Permit Number: --- � J r w Building Permit Application Pionning 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: Address: Legal Description:, (ti`s, C C Property Tax ID #: \ `A LA -- -1 p 2- -- \3 L 3 S Lot No. _&_ Site Plan Name: Block No. SC Project Name: Setbacks Front Back: ___ - Right Side: Left Side: ©E4�W,QESCRIPTION OF WORK: r CONSTRUCTION INFORMATION: fi omrWitiHVa work fere under this permit -check a —appy AC e� Gas Tank []Gas Piping Shutters Windows/Doors 11Etiectric ❑ Plumbing Sprinklers El Generator Roof Roof pitch Total Sq. Ft of Construction: SFt. of First Floor. _ Cost of Construction: $� ( _ Utilities: Sewer [] Septic Building Height: OWNER/LESSEE: - -- 1CONTRACTOR: - j Name J,- - '-J' City: _ �� L State: �I Zip Code: .;-VA c; _' Fax: Phone No. E -Mail T\\ i Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Name. y Company: �.• c C' o rs Address: City: t �" •. .- r State:_,_ l Zip Code- f Fax: 7 Phone No. '772- jL C,, [- E -Mail: A,, r( 1i c%:, ` NC [i'' til L State or County License: C p c 1 4S 1 1 �� If value of construction is 52500 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: 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 thepermit 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 improvemwe&its,,,t a . A Notice of Commencement must be recorded and posted on the jobsite before in financing, consult with lender or an attorney before comme co work or rt' ( , ,,p* o Commencement. STATE OF FLORIDA COUNTY OF rMpdreS o r ry The f ng instrument was acknowledged before me this,�� a 20 +_-by Name/6f pe0on acknowledging) (Signature of Notary Public- State of Florida J Personally Known OR Produced Identification Type of Identification Produced Commission No. (Seal) Revised 07/15/2014 REVIEWS FRONT I ZONING COUNTER REVIEW DATE COMPLETE INITIALS er Signature of STATE OF FLORIDA COUNTY OF r tl►if Vale of Florida 69 Coma►. EX111418 tact !3.2011 Commigion I FF 13&M 0wmd 1ho NINNr #iof' Am The forgoing instrument was acknowledged before me this J9 day of � [ 20 by (Name of person acknowledging) SLY+' (Signature of Notary Public- State of Florida ) Personally Known / OR Produced Identification Type of Identification Produced Commission No. SUPERVISOR PLANS VEGETATION REVIEW REVIEW REVIEW (Seal) SEATURTLE I MANGROVE REVIEW REVIEW