HomeMy WebLinkAboutpermit applicationALL APPLIC L NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 15 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line A
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Address:�y�QU IMQ(Ar�n1�ItJ0
Legal Description: QUOL `/i
Property Tax ID #: 132_-J- -1 d O LL -I 10 - ()() 0
Site Plan Name:
1-1 '
Project Name:
Setbacks Front
Back:
Right Side:
Left Side:
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Gas Tank UGas Piping UShutters
Plumbing LJSprinklers UGenerator
Total Sq. Ft of Construction: 5. Ft, of First Floor: _
Cost of Construction:$ 4 LQ� oc7 Utilitles:ISewer�Septic
tate:_
Zip code: 3u2 51 Fax:
Phone No._l2-y 1,Q U -6133q
E -Mail:
Fill in fee simple Title Holder on ninit page (if different
from the Owner listed above)
construction is $2500 or more, a
Name:
Lot No,
Block No.
f-IV/c
❑jj Windows/Doors
Roof = Root pitch
Building Height:
Address:. h' N lAC Nm4 I
City: FE ?I pY,. p State: Fl_
Zip Code: AL4q } Lr Fax: Z7 7 -•t �1 Z2
Phone No. Z'l2 - y� t _ x-1.1
E -Mail: u` r �n 1
State or County License:
.mmencement is reauired.
DESIGNER/ENGINEER: x Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
Address:
City:
Zip: Phone:
WMATION
MORTGAGE COMPANY:
Name:
x Not Applicable
Address:
SUPERVISOR
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
x Not Applicable
Address:
COUNTER
City:
REVIEW
Zip: Phone:
REVIEW
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 contlict 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
C_
as
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF = I COUNTY OF ST - LuC 1
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �� lS20 I7 by this day of RjvtQ kA5 fi .20 �_l by
SKIES JrAMn�
(Name of person acknowledging) (Name of person acknowledging)
-tVignature of Notary Public- State of Florid ) Signature of Notary Public- State of Florida
Personally Knowr)�� OR Produced Identification Personally KnownOR Produced Identification
Type of Identification Type of Identifica ot�uced
_ _....._.._...,.xR���
1 PI :Ap # , 089099 I - SUSAN NEGRO
Commission No. MYCO Commission No. •''•'i
E%PIRES:ApN2.202i .q,�
Ec„�r}r g���p*y �,i•': MY COMMISSION #GG 089099
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS