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
1300 Virginia Avenue,Fort Pierce FL 34981
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR:
Address: Q',o Timhlin VlinApld.
Legal Description:'J3 Dt40 P MP4.N And Isbg W MT cici-oR F 'b DF WE tW OF SE t W T+I
11+ r
Property Tax lD#: - - Lot No. L4 hs _
Site Plan Name:TIO Let� �[L0 C _ Block No.
Project Name: N A
Setbacks Front Back: Right Side: Left Side:__
1r%s1&o line Fri like aavaae docr 16x7
Additionalworktobepertormed under this perm -check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters ✓Windows/Doors
_Electric _Plumbing —Sprinklers _Generator _Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$2 (OeJ Utilities: _Sewer _Septic Building Height:
Name wlricicl rch Name: na LLt}/Pj�91
Address: I 1 Company: plm tis' nC O'f10Y0 Jbd aiyr r2.r
Cit, �4 fYCt Stater Address: 008 TomnAno4 Di
Zip Code: W82 Fax,-WA 4 City: Ld:.,r IJ.rbdw ge.ch State: FI
Phone No.C1T2)14 ULF)J on Zip Code: 32937 Fax: 321-777-4134
E-Mail:N Phone No. 772 337-4470
Fill in fee simple Title Holder on next page(If different E-Mail:
from the Owner listed above) State or County License: 17
ifvalue of construction is 2500 or more,a RECORDED Notice of Commencement Is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not ApplicableY�
Name: Name:
Address: Address:
City: State:_ City: State:_
Zip: Phone: - Zip: Phone: _
FEE SIMPLE TITU 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 Counttyy 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 wah 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
commenci work or recordinR Your Notice of Commencement.
S
_Signature of Owner/Lessee/Agent Signature of Contracor/License Holder
STATE OF FLQQrQA1 STATE OF FLgQ�DA
COUNTYOF -1'k'#'\11 d COUNTY OF rY'C\IQ.YCI
The fo Ding Instru e t was acknowledged before me The forgoing inst ent was acknowledged before me
this day of 20by this day ofVIAMN! ,20 by
a f peso aging) p ckno - IB I
nl
�I
'l atu is ¢-State of Florida 1 B bli-State of Florida
r OR Produced Identification_ OR Produced Identification
of entfi Produced c roduced
rr--rt ����� ,ryyam.p� "+� BROOKE apI�,,� SaGETI
Commission No. t UyJ MEXPIRES:Jum 'e019"— No. i p'gt�.SeOMMMII 0)N1FF2
EXPIRES:June
': afhewgEtnry Nene IliaNwM `�•...__s� EXPIRES Junu2G19
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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