HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED rl
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Date. T �� Permit Number: 1J
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Building permit Application
Planning and Development Services AU & IFS
Building and Cade Reguldtlon Division PE Rnf il'rj°.G
2300Virginia Avenue,Fort Pierce FL34982 St. hucie C; ;nty, FL
Phone:,(772)462-1553 Fax:(77z)46271578 Commercial. Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the-end of line
Address: 7
Legal Description: al unnna
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Property Tax ID#: �-t/ Lot No.�".
site Plan.Name: f(4, Block No.
Project Name: O.0 I f t -----
Setbacks f=ront Back:.Right Side:_ _.- Left Side:
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Rditigba wor o orme un er t is perms —c ec a appy:HVAC Gastank M-g[]Gas Pipinghuters Windows/Doors
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Electric Plumbing ❑Sprinklers Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities:�Sewer Septic Building Height:
Name Name:
Address: i I A rA 11%11_bo by. Company: 12
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City. Stater Address: r
Zip Code: Fax �9 �� City: r.-I — State:
Phone No. r '� Zip Cade:
E-MaPhone No.
Fill in fee imple Title Holder on next page(If different E-Mail: IlwC G ./?
from the Owner listed above) State or,83unty Incense: 500
If value of constructlon is$2500 or more,a RECORDED.Notice of Commencement 6 required.
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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,,LUI"e 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 pacts,fences,wails,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
impeovements 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
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commencing work or record'm your Notice of Commencement.
signatu n Le�<e gent Signal o'nt cense Holder
T7 F
0 FLORIDASTAT ARIDA S OF FLO
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COUNTY OF -St L-j-r'-i-e— COUNTY OF Lvc 16
The for-going instrument wa acknowledged before me The forgoing instrument was acknowledged before me
thls_&day of 20 1-9.1,"' this_Lt?. day of
20 by
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(Name of person acgnowledging) (Name of person-'dcknowledging)
(Signature of Notary Public-State of Florida) (Sigdature of Notary Public-State of Florida I
Personally Known r OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Produced_ Type of Identification Produced
Commission No.TOOCommission No.E
STI
WCK ISTINA L LOUDER 11 Acx
KRISTINA L LOUDER
All MY COMMIN�ONAW P22;;
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N EXPIRES
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Revised 07/15/2014 EXPIRES August 7,2017
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS