HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO 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 '14�1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: __ `0°1 2c C'.1�1CA iYl P IOn� l,<. a,14 , POC4 3� 4
Legal Description: Lo,,u, 4 P&A Iq I
Property Tax ID #: 333LI —SDI — 00:1Z — Ooo —"3 Lot No.
Site Plan Name:
Project Name: K I S
Setbacks Front Back: Right Side: Left Side:
Block No.
CO r i +cbn." +-o o-- 3.5 TOO/-
tvr � 10 KLO Iecfri C h-�Ci+ 54--rjQs
Windows/Doors
— " -I Roof Roof pitch
Total Sq. Ft of Construction: Sq. C S . Ft. of First Floor:
Cost of Construction: $ `1 �JS� , 0(7
Utilities: oSewer Septic Building Height:
Name_CAC-ob
Address:_ `tg'Z)�tI
City: ?OC� S� • UU-� State:
Zip Code: 3� � �� Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: Clpe E' -rel I CQ , U 0-.,
Address: in rrCP� •E t o L X11)
City: _51a
State: f --
Zip Coder IgLD Fax: 1-1a -11314-35 ►1
Phone No. -7-1 — g 71 — t Slip
E -Mail: 1'"�,JICC(E
State or County License:
if value of construction is 11100 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applica
Name:
Address:
City:
Zip: Phone:
State
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Name:
PLANS
REVIEW
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
_Not Applicable
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
commencingr recordilag- owr Notice of Commencement—
_ Signature of Owner/ Lessee/Agent
Signature
rise
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ �� S�'� Lt �(' ,(+� COUNTY OF `�J`�t` S4,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 -1 day of u 20 i Lby this L dayof, 20 n by
(Name of person acknowledging) (Name of person acknowledging)
r
(Signature of Notary Public- State of Florida )
Personally Known '� OR Produced identification
Type of Identification Produced
� I Commission No.
Revised 07/15/2014
398.0153
tg ature of Notary Public- State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
LINK"ARIE BOUCHARI I commission No. I "JDA MAMallbUCHARD
MY COMMISSION #FF12552611=.
MY COMMISSION #FF125526
398-0163
REVIEWS
DATE
COMPLETE
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
INITIALS