HomeMy WebLinkAboutBuilding Permit Application ALL 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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED"IMPROVE MENT LOCATION:
Address: :5A&IT-;+ `F 4iv iT p�' /nrETlt,
Legal Description: I0'Or ✓ e5TWTBr r Ur- t i Z TL-IG 1( "T-
tj 14 1=r o(-' LoT K3 MaaP 314 h(s ), ( opt. (.SZ- Z-ace :'I-7-Y o5 I
Property Tax ID#: 3 LfoZ —(o03 -alG f0co—5 Lot No. J
Site Plan Name: EILA yni Block No.
Project Name: ►'r�-�'
Setbacks Front Nl D Back: N M Right Side: ! If_Left Side: !�
'DET
AILED WORK:
UI I N dJ l ��A �r
�(�vl ti 6S _17NpA-C-T
CONSTRUCTION INFORMATION; j
Additional work to be performed under this permit-c ec a that appy:
_HVAC _Gas Tank _Gas Piping _Shutters A Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ 1400Utilities: —Sewer —Septic 'Building Height:
OWNER/LESSEE: . ., ,CONTRACTOR:'
Name SMr'i-l-. w'r-+-IAm kty,T0. Name:
Address: 1n.l cc �isvEfirt �/� Company: T���Ufc/ iyu,�/
City: lCiVi I ELC�t State: Address:.�- Address: / ?.c7 /1/dd
Zip Code: ' 'g l SZ Fax: City: Stat :-4�z__
Phone No. 172- 5'77 -.tbL(t 1 Zip Code: S Fax: 6 ff--97N y
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: IA41s91
from the Owner listed above) State or County License:
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 fai re/Notice
rd a Notice of Commencement may result in your ing twice for
improvements to your rope of Commencement must b corded ano on the jobsite
before the fir spa on: o io obtain financing,consu wi le der orney before
commenci wok rec tli of Commencement.
01
s
Signatur of wner/Less ouWactor as Agent for Own Signat re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF___57' 4Q 1,4_'r COUNTY OF
The forgoiD9 instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi _ y of20�zby thi&,22L4y of ZE �� 20/_?_ by
(Name of person acknowledging) (Name of person acknowledging)
(signature of Notary Public-State of—Florida) (Signat6re of Notary Public-State Florida)
Personally Known_)�OR Produced Identification Personally Known ^ ORI Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. Seal
iwY e& QAUMOND
MY COMMISSION#FF 173907Y '• ANN M.QAUMOND
MY
UsBiGN#FF M997
Revised 07/15/2014 .P Bonded Thru Notary Public Undenvrlers .'. EXPIRES'December 7,2018
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' RE�A Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW j REVIEW REVIEW
DATE
COMPLETE
INITIALS