HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
110Date: Permit Number:
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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 I Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED 1MPROVEMENTLOCATION '
Address: 5w Pa'o15h %V Q9 ci
Legal Description:
!1 ����11 r
Property Tax ID#: J: �-"�0� —005 !�—0
� Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED ILED DESCRIPTION""OF WORK ,:
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kaQwem+ Qf 50 2�Lk de-46c. uJa0 We-kt
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CONSTRUCTION INFORMATION:,'
Additional work to be nertormed under tis permit-c ec a t "t
apply:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers ElGenerator F]Roof Roof pitch
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Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Utilities: _Sewer Septic Building Height:
OWNSR/L"ESSEE; faa
TRACTOR; y
Name Q2� 6 V\ O :
Address: 5 S 0. S v� any: au� t CUPW
City: �'+ (Q�CQ. State: �� ess{: Z� �
Zip Code: 5 Fax: City: -bf, pp cj a State:
Phone No. 5u _g(ol _ �—W Zip Code: 308fO ' Fax:
E-Mail: Phone No. -7-712-777- Obl
Fill in fee simple Title Holder on next page(if different E-Mail: WR, Kk V WE e `-y V od. (.35(N
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from the Owner listed above) State or County License: C`-C )L 29 0gq
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.'
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: f
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Add cess: 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,iniall 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 jlender or an attorney before
commoAemgwork or recording your Notice of Commencement.
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Signatyfe of Owner/Lessee/Contractor as Agent for Owner Signature o C (ntractor/License Holder
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STATE OF FLORIDA STATE OF FLORID *�
COUNTY OF :1.d meq_+ COUNTY OF 0—
The
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this_a__day of 20 k )—by this Al day of 20 ___L by
(Name of person ac owledging) (Name of per n acknowledging)
(Si re f Notary Public-State of Florida) (Sig e f Notary' Public-Stat f Florida)
Personally Known OR P odu dation Personally Known I OR Produced Identification
Type of Identificatio. HANNA I orida Type of Identification Produced
, Y'PU Notary Public pec 20,201
Commission' cci" .'c i s .SHAHNA INGRAM
Exp f f;eaDA77249 Commission No. a,p
mm• (Se State of Florida
ission Assn. ar��. B��.; Notary ublic-
s s.
GOO",wough National Notary
My Comm.Expires Dec 20,201
77249
Me
Revised 07/1 o' °� Bonded through National Notary Ass
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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INITIALS