HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� I (� / Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981 /
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: `kscD, M e- -zC1er
Legal Description:
/V 13-5 4
Property Tax ID#: o2g041' (,D7t- Ud.IS- OOJ-� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: If'
£ONON INFORMATION:
Aa
itwna wor
tobepertormed under this permit -cher all that aao v:
HVAC
biLlectric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $/-/90.047
Gas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
_ Roof = Roof Pitch
Utilities: -Sewer —Septic Building Height:
OWNER/LESSEE
CONTRACTOR:
Name RA r> fl'
Name: WNI.- C.
Address: 3 o �2�zr
Company: cw�
(tel
City: JQ+ Pi erce., State: -
Zip Code: 3`{c q] Fax: ti 14
Phone No.
Address: 141 fi 5? Pe sSLer
&,ri ,
City: f-+- P-ercr
Zip Code: ji_ti Fax:
Phone No. 'iia-- 4 J
State:
,blA .
- Q
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: e1 wMe 1,q c
Cann C13 �'la
State or County License: .26
7?�
it value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
VEGETATION
City:
Glf". 2
City:
COUNTER
Zip: Phone:
REVIEW
zip: Phone:
REVIEW
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
as
SATE OF FLORIDA TE OF FLORIDA
COUNTY OF 31 ICOUNTYOF S/ . 11A.1C -e
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
Yi
this _&tlay of IIAt u c 20 Eby this day of .n kc,- 20I-12 by
Ll
(Name of person acknowledging) (Name of person acknowledging)
(Si ature of Notary Public- State of Florida I (Signature of Notary Public -State of Florida I
Personally Known OR Produced Identification Personally Known t/ OR Produced identification
Type of Identification Produced Type of Identification Produced
Commission No.
Revised. 07/15/2014
Commission No.
tlelary Public - Sate of Florida
COM4111011 I FF 965546
(Seal)
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M. E><Plrea 54
REVIEWS
FRONT
ZON
NS
VEGETATION
SEAT
Glf". 2
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
R
DATE
COMPLETE
INITIALS