HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0oci—_-\ \--A 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 line
PROPOSED IMPROVEMENT LOCATION:
Address: L4 � q l
Legal Description: l �aC� v ����.., A� V .� �vNr" k?^_A L' kc�
Property Tax ID #: 14t t --�cR �k � • VC�•-'A
Site Plan Name: {{
Project Name:
Setbacks Front Back: Right Side
DETAILED DESCRIPTION OF WORK:
Left Side:
Lot No,
Block No.
CONSTRUCTION INFORMATION:
AdditiorW work to bj rtormeci under this permit - check all apply:
E, HVAC Irl Gas Tank OGas Piping In Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers 11 Generator F] Roof Roof pitch
Total Sq. Ft of Construction: Sq.
S Ft. of First Floor:
Cost of Construction: $ ; ,t�� .� Utilities: Sewer E Septic Building Height:
OWNER/LESSEE:
Name _V e c1 �r
Address: �,(, . nLr� c�.�(
City: State: �-
Zip Code: L Fax:
Phone No. ��` --Ic `+'`� .f_� V�sr-
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:�cuw �l
Company:
Address:
City to !"Ic O State: fl—
Zip
Zip Code: ('00 Faxes - -(4 q9
Phone No~'��r
E -Mail: K
State or County License: &L -Lo
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN 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 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 recording your Notice of Commencement. _
s
_ Signature of Owner/ L e Age t Signature of Contractor/l.-i'cens older
STATE OF FLORI A STATE OF FLO A
COUNTY OF COUNTY OF
The forgoing instr�w s acknowledged before me The forgoing instr{�ment was acknowled d before me
this da of 6-9Q 20 l icy thi day of �[C.�1 C--' � 20 by
(Name of person acknowledging) (Name of person acknowledging )
Si nat of r Public- Statel�f Florida )
(Signa re of�Public-tot~ary Sta�C.af Florida) ( g
Personally Known AOR Produced Identification Personally Known 11 urt Produced Identification
Type of Identification Produced Type of Identification Produced
S JOYCEMICHAUD �
Commission No e ( p� commission No s�Yr�?, (5ea;YCE�9ICNAIJD
1NyZ bMM15510N # FF 063006 .- W COMMISSION # FF 083006
. T EXPiFES: April 2S, 2016 EXPIRES: Aprl! 25, 2018
W'-% NnndadYhtu hatary r+uhl a Unden+r�eR I
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
SUPERVISOR ' PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW