HomeMy WebLinkAboutBuilding Permit application.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: `"1 e Z O L Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Building Permit Application
Commercial Residential
t/
Property Tax ID #: `� ia�D �' ('j �� Lx� _ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
* Mechanical
Electric
_ Gas Tank
Total Sq. Ft of Construction:
Plumbing
Cost of Construction: $
_, Gas Piping
_ Sprinklers
— Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _ Sewer r Septic
NameM� Y_ l fel _t c),1ti _ s V_
Address:_
City: Stater
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: Cunt-, Sammon `5
Company: 15a n Lr 5u Sfieins )>L c—
Address: t(e I S S E S 1(ap ren Dr
City: VOQ-C ST LACI State:
Zip Code: 342&1) Fax: `172 33S 1 �t6 F
Phone No. 77j 33,5 -30-3l-
E-Mail: C-Usta,kr "S4, V C,01.(,M
State or County License: Cfl C 0 5 ) 91 O 54cLtz
if value of construction is 25Kor more, a RECORDED Notice of Commencement is required.
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SUPPLEMENIALCONS IRUC IION LIEN LAW INFORMAIION:
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:
i
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 thepermit 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 recp1rding your Notice of Commencement.
C
s
Signature of O%vner essee/Contractor as Agent for Owner Signature of Contra or/License Holder
i
STATE OF FLORIDA (Y STATE OF FLORIDA
COUNTY OF V 2� U L' l E' COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me j
this 3L% day of Apt 1 20 1 `lb} thisZ' day of C' ��� 20 Al by i
al mvn s _ eu rzTl 5 snwi my rl 51
(Name of person acknowledging (Name of person acknowledging)
g)
/L <' �'a-4
Notary Public- State
(Signature of of FI a ) (Signature of Notary Public- Stat of Flori-
1*"'�
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification j
Type of Identification Produced Type of Identification Produced
Commission No. 61 6 0 5� Yb "a cE, CHRIW E6 mission No. U1 Q
MYCOMM{MMIli 052646
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Revised 07/15/2014 * * COMMISSION/Gfieme
`oma EXPIRES: AM 4, 2021
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW ; REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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