HomeMy WebLinkAboutBUILDING PERMITALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:S -IS'-17 Permit Number:_
~-'.~."'=...-...."--'l':J -::=-'_,•...'-..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 XI
PERMIT APPLICATION FOR:To Select from dropbox,click arrow at the end of line
Lot No._
Block No._
Project Name:_
Setbacks Front _Back:Right Side:Left Side:_
DETAIl:;ED DESCRIPTION OF WORK:
.CONSTRUCTION INFORMATION:
o Windows/DoorsoRoofD Roof pitch
Total Sq.Ft of Construction:_
I {Y'()O·OOCostofConstruction:$__'-1--'-....:.....:;..-=--_
S~of First Floor:
Utilities:USewer DSeptic Building Height:_
:OWN-ER/LESSEE:CONTRAe~OR:
li9:ene-Hav ~Name:_SO~T j)....LC:1....LiJif~tI:m~_
Address:f/{/1 JbcmPCh U t -i /J €/Company:A\Jlhd6d1L 4J;:f f~t-}reGlHlrv (~
City:k+e;erce,..State:EL.Address:/l21 &Molb+AII~.
ZipCode:~Fax:_--:--______City:y£p{~C.e/State:fL.
Phone NO.~'"11./S'1.Zip Code:,sy/t~2--Fax:I7'd.,...l-{tI'-t6fj6i..(C(
E-Mail:Phone No.)(2-l.f6S'-1f()6
Fill in fee simple Title Holder on next page (if different E-Mail:C~vojl)t~ge.rferfl'''ijts@Hod=~t',UJp'1
from the Owner listed above)State or County License:"GO 660'hi L~',~=-;ff~~:;:-;:!;;------
If value of construction is $2500 or more,a RECORDED Notice of Commencem nt is required.
s
_Not Applicable
,_r<
SUPPLEMENT.l\L CONSTRUCTIO,,~LLEN LA,!,INFORMATI9N:
_Not ApplicableDESIGNER/ENGINEER:
Name:_
Address:_
City:-.,-State:__
Zip:Phone:_
FEE SIMPLE TITLE HOLDER:_Not ApplicableName:_
Address:_
City:--:--;--_
Zip:Phone:_
MORTGAGE COMPANY:Name:_
Address:-::--_
City:-=:-State:__
Zip:Phone:_
_Not ApplicableBONDINGCOMPANY:Name:_
Address:_
Citv:-:--_
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 structurewhichisinconflictwithanyapplicableHomeOwnersAssociationrules,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.~.~,-viLJ.,22-S~~
Sigmfture of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
Personally Known /'OR Produced Identifica~l"~~Personally Known r=OR Produced Identification _
Type of Identification Produced ~'\\''\\l.>iE E C,q!'f(;',Type of Identification Produced -:-=c;;-;-;c--_~~.·r'\~issi.t-9.;~;:;,;.\\\\\\1 iH lilll///JA
Commission No.£r.<Q 7-</.2.5".9 (~I).{cP\{~arY2?·v'';''·,:~~ommission No.F.r.C>7j("':;?5%'~S@~~.~~.C1&~}1-.
::::~,>'I><:::'<"o'io·'-.~.··"MISSI·.'9....,'.~-:::*.;..>-•:.'"".0 <:,0'"101;"'<-;--:•..cP~:",.~..~,~~~arY21,0'J:-c ~.:
STATE OF FLORIDA
COUNTY OF r--Sv La Cd;e
The forgoing instrument was acknowledged before me
this .J.E!:..."dayof ;t1c)'.20 r.Zbv
~VIII a~i Tc·DUr)ftJCA/ih
(Name of person acknowledging)
(Sighature of Notary Pub1k-State of Florida)
STATE OF FLORIDA
COUNTY OF r---7r.Luc,.e
The forgoing instrument was acknowledged before me
this £'l1ay of ~(•20 ~by
~Ci YhU~('1 l)liu"hdM
(Name of person acknowledging)
(6ignature of NotarVPublic-State of Florida)
Revised 07/15/2014
REVIEWS FRONT
COUNTER
ZONING
REVIEW
DATE
COMPLETE
INITIALS