HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUSrT►BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �� 9 Permit Number: �C(�
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Building Permit Application AUG I �
Planning and Development Services PCR;P1 i 1It�G
Building and Code Regulation Division ct, Lucie Cou')tY7 FL
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
Address: 0&/ _
Legal Description: -/ 0,0 rl�ll��.o /1� �2
Property Tax ID#: 0?8 Lot No.�
Site Plan Name:�i,�Q�rs-rr,�,�,) Block No.
Project Name: �r,�y ,o
Setbacks • Front Back: Right Side: Left Side:
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Aciclltlonal work to e errormecl un er t is permit-c fieck all appy:
HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers EiGenerator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
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Cost of Construction:$ Se Utilities. _Sewer Septic Building Height:
Name Na / v
Address: 11 . Company:
City:IZ24 State: Address: / W�r)
Zip Code:_ 7i /� Fax: City:/11 State:-4/-
Phone
tate:Phone No. Zip Code:��c3` Fax:
L�x1® �-� kn S i Phone No.mple Title Holder on next page(if different E-Mail: Qwner listed above) State or County License: �'C�lCt3 N. 14
nstruction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY- _Not Applicable
Name: ,(_ :z1 Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: !Ng�t Applicable BONDING COMPANY- _Not Applicable
Name: 1? 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.
41s
_Signature of Owner/Lessee/Agent nature of C ractor/Lice a Holder
STATE OF FLORIDA STATE OF FLORID "&/—
COUNTY OF COUNTY OF
The forgoing instru was acknowledged efore me The forg ing instru t was a knowledged before me
this day of 20 J�by this day of 20 L by
(Name of person acknowledging') (Name of person acknowledging
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(Signature of Notary Public-State#Florida) (Signature of Nota Public tate of Florida)
Personally Known , OR Produced Identification Personally Known OR Produced Identification
Type of Identificati n Produ , Type of Identification Pr
low Notary Pahlic Stats o Florida Notary Pkbk%gtato of Florida
Commission No. F(> Donza ommission No. �' France .lea
Q My commission GG 092440 y� c My Commission GG 092k40
ory�o� Expires 07/2712021 '�t�po� Expires 07127/2021
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS