HomeMy WebLinkAboutpermit 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
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 fine
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: jC{ y�-�O�— (}/L1(0 — 0cp-- 'F� Lot No. 1_
Site Plan Name: Block No. -�J,
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
� (A Ste. p— N C7 &1-�
CONSTRUCTION INFORMATION:
AUU —it iona wor to e e orme un er t is permit — c ec a app y:
HVAC Gas Tank Gas Piping ' Shutters Windows Doors
11 Electric Plumbing Sprinklers Generator 0 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ F ►00 11�
OWNER/LESSEE:
Name ll
Address: ()'L u t -
City: 4 , - State:
Zip Code: ) 3 Fax:
Phone No.
E -Mail:
S Ft. of First( Floor: _
Utilities: Sewer [:] Septic
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: 1._ a C {{ 70 4 (
Building Height:
Company: VA./('- q--Yyt 1
Address i — -}
City: �, tach State:
Zip Code: Lrt -1 Fax: 3
Phone No. L- 3
E -Mail: 4�
State or County License: t RnQA:,-1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
up: Phone:
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY
Name:
Address:
City:
ZIP: Phone:
BONDING COMPANY:
Name:
Address:.
City:.
Zip: Phone:
Not Applicable
e:
Not Applicable
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 Lyraf Your Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLOI A
COUNTY OF -t
The forgoing instr mens was acknowledged before me
this VWday of 20 nby
ao—
(Name of person acknowledging)
Fe of Contractor/License Flo
STATE OF FLOR D
COUNTY OF
The forgoing instrument was acknowledged before me
this i�ay of C,- 20 n by
(Name of person acknowledging)
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
SUPERVISOR PLANS
REVIEW REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
s.
ignature of Nota ublic- S
to of Florida J
(Signature ofNotary blit Sta of Florida }
Personally Known
OR Produced Identification
Type of Identification Produced
Personally Known
OR Produced Identification
Type of Identification Produced
Commission Nor- 0
pY n �.,,
LESLIE ZELAY
Sion No.
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cy'a,�
5ea11 SLiE ZELAYA
Notary Pulpit - State o
Florida
Notary Public - State of Florida
Commission # GG 018251
Revised 07/15/2014
MY Comm Expires Aug8, 2020
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My Comm. Expires Aug 6, 2020
Bonded through National Nolary Assn
Bonded through National Notary Assn_
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
SUPERVISOR PLANS
REVIEW REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW