HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)4624578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED2IMPROVEMENT LOCATION:
Address: i�U)•�- �.�� l)}'D �,�, 3t
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Property Tax ID#:,ril2 )d_ Id)f711S1? 1-000—
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Left Side:
Lot N
Block
DETAILED DESCRIPTION OF WORK: All
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CONSTRUCTION INFORMATION: III
UI
IJ
Gas Tank OGas Piping
Name
U_Shutters
LI�i1Windows/Doors
IIHVAC
IlElectric
F-1PlumbingSprinklers
Generator
ImoRoof Roof pitch
Total Sq. Ft of Construction: S
Ft. of First Floor:
Cost of Construction:$
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Utilities:�Sewer
City: State: f(,,
Septic
Building Height:
Zip Code: U Fax:
OWNER LESSEE:
CONTRACTOR:
Name
Name: VII-FrirA -11,
Address:
1
Company:
City: State: f(,,
Addre
Co
Zip Code: U Fax:
City:
Stater
Phone No.
Zip Code:
Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page I if different
E -Mail: YJ Cil
from the Owner listed above)
State or County License:
,� .... „ --..,....o.. n pow m more, a newnncn nonce in wmmencement is regwrea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
MANGROVE
Address:
COUNTER
City:
Zip: Phone:
State: _
City:
Zip: Phone:
State:_
FEE SIMPLE TITLE HOLDER:
Name:
_KNot Applicable
BONDING COMPANY:
Name:
[Not Applicable
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 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
STAE OF STATE OF
COUTNTY OF �,�(19YiA {..IIIs.LQ ICOUNTY OF�\L�ei'i'i �L1lID
The fprgoinginstr entwa acknowledgedlbeffore me
this day of 20 y
(Nameofpe n acknowledging)
(Signatulle of Notary Public -State of Florida )
Personally KnownOR Produced Identification
Type of Identification Produced
Commission No. JAMIE 0 G
� � •) Notary Public - S
Commission M
m. .Dre
Revised 07/15/2014 Bonadnrouph NMk
The forgoing instrugtent was cknowledged before me
this 4rL&ay20
p�by
}� i�t d E jl9 ifi kk
(Namep4ersI acknowledging)
I� n
(SlgnaturidofNotery Public- State of Florida )
Personally Known _'Y OR Produced Identification
Type of Identification Produced
- Stale
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS