HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
a
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
PROPOSED IMPROVEMENT LOCATION:
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Address: ZY�`J�1 KA1nbow �� f, G�12�C.Q L- �� 61IK
Legal Description:5 36 10 FKDM ME (--K, OF N SIS % S 12 o� � ( vF � �y Ru�S ZM Ft ►v
Ku 11 e-7 Mrq zri m,N w10%,q+f, 7h Iv 6W tt Tt�
1rfi foPoB.1N CvN7wIDUt TfIS JG2.5 THE W�1 Tl/�! 162.5 fofloB���
Property Tax ID #: 3405 - L{ � � -•O(�U OI �. Q�(�— 3
Lot No.
Site Plan Name:
Block No.
Project Name: b
Setbacks Front Back: Right Side: Left Side:
DETAILED,.DESCRIPTION OF WORK:
ch"C'e- out i� ►, . LonQ..1` Wn-ter -}-o ou 3101J �
�•��"h I
0'K�0 •04-e� (:I- +�-C cf- S4 -r I ('5553-1361t4ao3-W'7$�
CONSTRUCTION INFORMATION:
r orme un er t is permit - c
j na wor to om,
ec a appy;
L�JHVAC Gas Tank Gas Piping
Electric
_ Shutters
❑
Windows/Doors
Plumbing Sprinklers
Generator
0
Roof Roof
Total Sq. Ft of Construction:
pitch
Cost of Construction: $ ,�o�i . 00 Utilities:11Sewer
SFt,
of First Floor:
DSePtic
Building
Height:
OWNERAESSEE: s �;.
CONTRACTOR:
Name O
Name:
Address: Z%501 K0.10bCx1-)
Company: ��
(Jt
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City: Tt . P 1 �r c-2, State: _(,
Address: � � n�
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1 C� Lt �
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Zip Code: 3 CJ ` Fax:
& *)II
Phone No. '1'73 ` ;'�0 1
City: fb,�T S� , t p-
0 -e2
� State: f:,i--
E -Mail:
Zip Code: z 4'll�0
Fax:
Fill in fee simple Title Holder on next page ( if different
Phone No.= ;1 71 - I SloO
E -Mail: C f 6. ir7°+C
from the Owner listed above)
State or County License; -09q
►-/
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
UMUNLK/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name: _
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
_Not Applicable
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
commend ngr recordine4r Notice of Commencement------
Signature
ommencement.—
Signature of Owner/ Lessee/Agent
Signature
Holder
STATE OF FLORIDA STATE OF FLORIDA('
COUNTY OF t SE-, 0 1 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this K day of _�2c2Mi'_�—OC 20 -by this L day of 20 A by
1 (Name of person acknowledging) (Name of person acknowledging )
r
(Signature of Notary Public- State of Florida) 4igature of Notary Public- State of Florida )
Personally Known 'I OR Produced Identification Personally Knowny OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.
I
Revised 07/15/2014 �
REVIEWS FRONT
COUNTER
DATE
COMPLETE
INITIALS
LIN"ARIE BOUCHA
'� MY COMMISSION #FF125;
7�1�•—'—�XPI{aFC �A.. �� ten.
398.0153 FlorldallotaryService.com
ZONING SUPERVISOR
REVIEW REVIEW
Commission No. ,
r, Oi fLr+
t 1407) 398-0153
PLANS VEGETATION
REVIEW REVIEW
IVDA MAMOIJbUCHARD
MY COMMISSION #FF125526
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