HomeMy WebLinkAboutBuilding Permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: %,r` Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROMS <o IM., 7, ENT Lt3CAT�CJI�I.
Address: 7 Z&V Robel �5'
Legal Description: t-4kt oMr law* - )911k 165 607-5 �r
Property Tax I D #: / 01 615�7—_ OW -
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side; Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATIOW
orme n uert ispermit-c ec a appy:
Additional work to flGasTank
❑HVAC Gas Piping _ Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers ❑ Generator E]Roof
Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ t % 7rf>. �(� Utilities. SewerSeptic Building Height:
OWNER/LESSEE: _ ...
OtiITIACTR:
Namen, U l'frj
Name: og5o'y «O k'ty ci
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Address: M\O/
Company: Se(A6
City: PE PVP rCe State: Et-
Address: f 1f fl 5E_ I -f-S,
City: �fiC% t
- State: 'yrs
Zip Code: �45 Fax:
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Phone No. (�(P) 1 } QQ qi -- -- - ---
Zip Code: '3C(ff b Fax:
E -Mail:
Phone No. (711), - C240
Fill in fee simple Title Holder on next page ( if different
E -Mail:
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State or County License: 2Rd
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from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPt_EM1 l�JT ►L CQN�rtt V '41 N ,Lt N L�`k1N tNl=OtiNIa1"tt N ,
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 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 rec-Qrding your Notice of Commencement.
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Signar o w r/Lessee/Contractor as Agent for Owner
Signature r or i nse Holder
ST E OF FLORIDA
STAT OF FLORIDA
CO NTY OF
COUNTY OF ,/"t�r,�i_,,._
The fora instrumwa acknowledged before me
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The forgoing instrument was acknowledged before me
To
this day of 20/7by
this7�"day of 20 # l by
Asa00 �kd/,ri...s
�j�scry
(Name of person acknowledging)
(Name of person acknowledging)
nature o otary Public- State of Florida)
ature of No ublic- ate of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced l` 12-e_
Commi
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Commissio
KEVIN T BU
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^`,ROSARY
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�. Notary Public State of Florida
K`n Notary Public - Stat7NotaryAssn.
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RCV15 f, 01�ommission # FF 059685
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS