HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `tel � 1
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 o' line
PROPOSED IMPROVEMENT LOCATION:
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Address: I � 1 � f lC'� icon ���,. � \12 e' 0r 3�R�C�1
Legal Description: C -e p ' CI C ��7 -N IP- t 1 1 -7 f,_) t
Property Tax ID #: (
Site Plan Name:
Project Name: \1C1(V\Q �y 1
Setbacks Front Back: Right Side
DETAILED DESCRIPTION OF WORK:
Left Side:
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Lot No. I
Block No.
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Company: 4-1 Ear 1�irC�
Address:
City' �0� P4,f',n \, State: -EL
Zip Code: 93y 26 Fa:
Phone No. '-14—L4
E -Mail:
q 11
State or County License: 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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 bluild the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants thatay 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 y ur paying twice for
improvements to your property. A Notice of Commencement must be recorded and p�stecl on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or anttorney before
commencing work or recording your Notice of Commencement.
7il�r,Ic ✓r ml-, Qin � �4NeH�r
S ature of Owner/Lessee/C oras Agent for Owner Si ure o ontr ice
STATE OFF DASTATE OF FL DA � I
COUNTY OF��,\�� \\st��� COUNTY OF„
I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z'� day of . (\� 20 17), by this K.Y� day of Phpf-) L 20 L-1 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of F orida'j �' (Si;nature of Notary Public State df lorida
Personally Known R e l f Identi i *& Personally Known rodu ed Identification
r�
�P•...tr'Ct Type of Identificat
ion oduced
Type of Identification Produc q 4nc_
* _ uummibotun /FF242393 �"N% �I 0''' LEXPIRES:
.'pears
EXPIRES: June 21, 2019 kPa4•�l�e���
Commission No. �SeaI�RONNOTARY.COM Commission No. a f'= YFF242393
` =+rte �e 21, 2019
NOTARY.100111i
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nn, �a•
Revised 07/1 ;/?01,1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -
COMPLETE
INITIALS