HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICAB E INFO M '" T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
®ate:0 Pert -nit Number:
Building Permit Application
Planning and Developrnent Services
Building and Code Regulation Division /
2300 liroinia Avenue, Fort Pierce FL 3498.2 �U
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To elect frorn dropbox, click arrow at the
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Address: (ill? GL Cy 62r�
Legal Description: La- �>° i,v0'0 Le, I'l� (I i,1 7 -')31 t k
Property Tax ID #: 1.36�/ 4d2 - 0/Sa -add — 25 -
Site Plan Name:
Project Name:
Setbacks Front_ Back: Right Side: Left Side:
C y/►G liC Gd S h ,'7�1 a -h, l h ,S- f Zll t l7 e u%
Seed f A0111l(V_C 1/hd G�zaY y e
ISS
Lot No.
Block No.
Additional worK to be ertormed under tnis permit— check all t= apply:
HVAC 0 Gas Tank Gas Piping _ Shutters windows/Doors
IJElectricL=1 Plumbing Sprinklers El Generator E�.koof Roof pitch
Total Sq. Ft of Construction, / Sq. Ft. of First Floor:
Cost of Construction: $ � Utilities: JSewer E]Septic'Building Height:
pg
Name t / C
Name:
Address: d� i— Grit `jle
Company:
City: �Or 0 er6y_ State:
_
'Add ress;3 I
City: VG�1"� �� ekZq? • State:^
Zip Code: % Fax:
Phone No.
Zip Code: I Fax:'
E -Mail:
Phone No.
Fill in fee simple Title Holder on next page.(if different
E -Mail: la;Lr
from the Owner listed above)
State or County License:
It Value of construction is S25oo or more, a RECORDED Notice of Commencement is required!
21
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
SEA TURTLE
Name:
Address:
REVIEW
Address:
REVIEW
City:
State:
City:
I State:
Zip: Phone:
Zip: Phon .
I
FEE SIMPLE TITLE IiOl _ R:
Not Applicable
BONDING COl Y:'
� Not Applicable
Name:
COMPLETE
Name:
Address:
Address:
L
City:
city:
Zip: Phone;
Zip: PhGne:
I
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-,u�h
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 revie� : 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 resu9t 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.
ignature
as
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I COUNTY OF
The , oing instru ent was a� cknowledged before me
this day of 20 . —b
LICONA >:
person ack , nlr 7? Commission 8 FF 983578
m Apr 18,
20
- My Corri
t !a o-�o, :a nded h ough NlatiAna4Notary Rssn.
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No., �40 (Seal)
Revised 07/15/2014
The forgoing instrt ent was lack
*hity of I
IA_,� L ,�
(Name of person acknowledging
(signature of y
Personally Known
Type of identifica,'
s
r:
edged be ore me
201 11v
Florida j
P���� MComm. ExUn # FF
; ° y 234730 �4
Commission No., I 8ondedthrou �� Ray 27.2018
9h ationai&iotarygssn.
REVIEWS
FRONT
ZONING
SUPERVISOR.
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW,
I
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
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