HomeMy WebLinkAboutBuilding Permit Application L APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I 1
Date:
Permit Number:-
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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.
IERMIT APPLICATION FOR: To Select from dropbox, click arrow at the ends:of line
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PropertyTax lD#: EkL 01 1 -?O l -00 ON -000-rj Lot No.
Site Plan Name: Block No.
Project Name: 1 '
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Setbacks Front Back: Right Side: Left Side: I 1
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itiona wor to e e orme un ert is}permit—cieck all appy: I
HVAC Gas Tank ❑Gas Piping _Shutters El Windows/Doors
Electric 0 Plumbing Sprinklers E Generator EI'Roof'
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ IN®•.3 1 Utilities: _Sewer 1:1Sepic Building Height:
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Name Name:'.,,spCtr�>� Z�}'�� (L i S-1 t f—
Address: 0 Company:a4-cn 0-_a i-Jze6'LA--x- -�� L.
City: �tici,tln - Stater Address: lQ ( � '7C,'(' i 6:Lf
Zip Code:_7 77 ®Co Fax: city: I.v �vti!E�ic�c` C��� Stater
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E-Mail: Phone No. tol-
Fill in fee simple Title Holder on next page(if different E-Mail:
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from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGN ERJENGINEER: _Not Applicable MORTGAGE COMPANY: '; ' Not Applicable
Name: Name:
Address: Address: I
City: State: City: I. State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ! Not Applicable
Name: Name: I
Address: Address:
City: City: { I
zip: Phone: Zip: Ph i ne: ;
1 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 thepermit 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 Amendmen+s.
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 youripaying 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 orian attorney before
commencing work or recording our Notice of Commencement.
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_Signature of Owner/Les ee/AgentSi a tir of Contractor/License Holder ,
STATE OF FLORIDA STATE OF FLO DA
COUNTY OFj�'fi ) a �, COUNTY OF �i�
The for of��ngg instru nt was cknowledged before me The forgoing instrument as acknowledged before me
this Way of,N 20 Eby this�day of �-D ,• =20 n by
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(Name of person acknowledging) (Name of person acknowledging,};
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4(, gnat-ur_e of Wotary Publi -St a of Florida} (Signatur f Nota u!lic-StA of Florida}
Personally Known OR Produc d Identific tion_� Personally Known OR Produced Identification
Type of Identification Produced��� iIlk� � 33a 085 0 Type of Identification Produced '
i °"AYaus c ANGELAYQUNG
Commission N 0ld-71 twat a.�SealpARIAMATILDEESQUIVEL C mmission No. =ti. Ft MY'C046eg #FF 951059
Notary Public-State of Florida N��) EXPIRES:Apri112.2020
Commission#GG i 01271 �rF Co-, sot tod fire Budget Notary sett cEs
Revised 07/15/2014 Banded through NaiionalNotary Assn. 1
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA j1014 SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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INITIALS f
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