HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S ` Permit Num
Date:
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: J,� y l L ea/i' S 1 J7&, ,, e
Legal Description: �1 o r f_A < e. to M o, C h -C_Y,
Property Tax ID #: Lot No.
Site Plan Name: A if Block No.
Project Name: (K OG IG y
Setbacks Front Back:
Right Side: Left Side:
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ydltional worKto be errormed under this permit—check a
HVAC F] Gas Tank Das Piping
Electric 0 Plumbing OSprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ o2 i V g y o a
apply:
Shutters Q Windows/Doors
Generator a Roof
S Ft. of First Floor:
Utilities[]Sew er 11 Septic
Name&j2e_Kq
Address:
City:. �%;,C�C'GL� State: �L
Zip Code: Fax:
Phone No. 20 , %Q
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
Name:
o inCompany:
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ter- u
Address:
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City: �%
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State: 1�
Zip Code:
3 9 6
Fax:
Phone No.
E-Mail:_40m,
State or County License:
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: ° _ Not Applicable
Name:
Address: 4111
City: U State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone.
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Ph ne-
BONDING COMPANY: _Not Applicable
Name: fA
Address:
City- VV 1 11
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'/s:
legignat6re of OWner%Le!?see/Agent z iKnatufe of ContractepXicenre Holder
STATE OF FLORIDA ' STATE OF FLORIDA Q
COUNTY OF �� L�C�L� COUNTY OF �_ 2 k1LC LQ_
The for g instr "°"'nt was cknowledge efore me The Zday
g instr ment was acknowledged efore me
this day of 201by this of .20 by
(Kk,
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(Name of person acknowledging) (Name of p rson.acknowledging )
(Signature of NotUy Public- State of Florida) (Signature of Not Public- State of Florida )
Personall h ..,-.-'•OR-•Produced-Identifl ri ersonalIv n OR Produced Identification
d P oduced Type of Id n iffy pion .I
:� r: r *� Notary P ate F�
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Commissi o,�a°`P °� (5e��)}Eb Commis 3t �2'� Y bli - St of
_- •' el'.27 2019 :.� !iID + ac �Nssion # FF 234730
* ri0r , F °F F`OP��`� My Comm. Expires May 27, 20
q r a.0 No ary/�s,Sq 19
oaryAssn. JP
2019`
Revised' 114? ;;v .i :ry Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
CCi.M P LETE
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INITIALS
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