HomeMy WebLinkAboutpermit applicationALL APPLICAB E INF 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address
Legal Description:
\i env'
611
Property Tax ID #: Q 0 1Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be ertormed under
HVAC M Gas Tank
11 Electric TK Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Name
this permit — check all apply:
[]Gas Piping Shutters
Sprinklers Generator
W
SFt. of First Floor: _
Utilities: Sewer []Septic
Address: GS12, M14 N q E la D f2 3 V e,
City: T—T 32 C_'(_' - State: ��--
Zip Code: '2— Fax:
Phone No.7�5 gS� CS
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Roof pitch
Building Height:
Name:..v/- !-KI ttD ` L_ lt�C
Company: Lf r) Q _11
Address:22.SS IqD
City: PF 12; f Y-Ltf StateE+
Zip Code: Fax:
Phone No.—7'72'W4 ` 197 6
E -Mail: y1 u r1
State or County License: CFC I 'Ri
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�L
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Ad d rens:
City: _
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 vour Notice of Commencement.
1-��- - s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDj VFLORIDA-__. �- 1
COUNTY OF t� COUNTY OF
The forgoing instrument was acknowledged before me
thi day of 1tell� x - C. w -4 20 nby
1
(Name of person acknowledging)
{Signature of Notary Public- State of Florida )
Personally Known O/OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
The forgoing instr pt was acknowledged before me
thisa l day of �b��c_y % , 20 J�__ by
(Name of person acknowledging )
(Signat re of Notary Public- Staof Florida )
Personally Known ./ OR Produced Identification
Type of Identification Produced
MICHELLE I{ftioI No.
W COMMISSIO # GG055253
(Seal)
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