HomeMy WebLinkAboutBuilding Permit Application ALL ICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 Permit Number] i.
III II II
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: rom rop ox, clic
M;
Address: S
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Legal Description: ffle ri-'iia)e req P_
Property Tax ID#: c2 V06 - 20 (OCG! 3 (OW' a- Lot No.
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be nertormed under this permit-check all iatappy:
F]HVAC Gas Tank F�Gas Piping Shutters F]Windows/Doors
Electric Plumbing OSprinklers FIGenerator 0 Roof
Total Sq. Ft of Construction: S Ft of First Floor:
L( cn
Cost of Construction:$ Util-ities. SewerF Septic Building Height:
g�g
Name:'..—X.,
Company: -.1-G,
Address: i 2 4 (p 1 1
Zip Code: Fax: city: State:_ -
Phone No. ?a, aLt o Zip Coder, L41 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE CO PAN : ,i No A plicable
Name: Name: C. -' Q` i
/address: Address:
tri-
City: State: City: kw Vr State:
Zip: Phone: Zip: Phone: D
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _.16Not 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 recording our Notice of Commencement.
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Sign ture of Owner/Lessee/Agent nature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORJQA
COUNTY OF � (a i e- COUNTY OF Z(,M e 12C
The for ing instr ent was acknowledged efore me The fo oing instru ent was acknowledged before me
thisday of 20 i_.by this�day of� 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of No a Public-State of Floridaj (Signatu f Nota6 Public; afie of Florida)
Personally Known OR Produced Identification !/ Personally Known OR Produced Identification
Type of Identification~Produced F1nF2jJA DI MUe� Uc&15� Type of Identification Produced
Commission No. r Q t'�3in` YPUSUC 20`11.P6�l�n A � oUNG
(+ T Commission No. A �j�}
STATE OF FLORIDA * M"COMJ� M#FF 961069
FFWWWN9j ` r `oe EXPIRES!ApHl12,2020
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS