HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
Building Permit Annfir;%tinn
Dity ;
toning Q"0 Uevempment Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
R e s 1' d e n
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of fi
ine
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Address: yA/y"-t UO
Legal Description: LckKes cO
Property Tax ID #: 3, 3 3 q
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Site Plan Name: Lot
Project Narne- To Block No.
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Setbacks FrontBack: Rip-, ht Side
Left Side,°
mm,
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1M. Electric
dotal e
q. rL of Construction.,
Cost of Construction: $ (00
S . Ft. of First Floor-,
Utilities: Sewer Septic Building Height -
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N a m e
Address: Lk
City:. A�A ` c,
State:
Z i p C o d e:
Fax: --
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E-Mail:
Fill in fee simple Title Holder on nextpage
if different
from the Owner listed above)
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Name:
Company.os Q LA2- U
Address:
City: YT s+-
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Zip Code:zi1q,!&L_._ Fax-, 1-7 -a ` l 3'
Phone No,
E -Mail:
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State or County License:
IT value of construction is $2500 or more, aRECORDED Notice Of Commencement is required.
DESIGNER/ENGINEER. Nfr,�,,lt Appeco b�e
Name:
Address:
City: State,.
Zip: Phone:
--- - - --------- -
MORTGAGE COMPANY: Not Applicable
Name:
Address: a.
City: State . -
Zip: Phone,
FEE SIMPLE TITLE HOLDER, Not Applicable BONDING COMPANY: —Not AppHRcab,.1e
Name:
Address.
City:
Zip® Phone:
Name:
Address-.
Citi:
zip., Phone: _w
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 awith�our aicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult yHome 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-reviewl 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 inspect'lon.,If you intend to obtain financing, consult with lender or an attorney before
commencingAvark-or recordtag44ur Notice of Comm encement�--_,
— Signature of Owner/ Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORIDA , -i----, STATE OF FLORID
COUNTY OF.- cOUNTY OF.—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
C (, 117
this day of 2 0 L,",b y
this a day of 2 0 by
III J,
(Name of person acknowledging) (Name of person acknowledging)
(Sig -nature of Notary Public- State of Florida )
Personally Known lv� -OR Produced Identification
Type of Identification Produced
IE ature of Notary Public- State of Florida
Personally Known �� OR Produced Identification
Type of Identification Produced
Commission No. LIN ARI BOUCCA RIlCommission No.
6
MY COMMISSION #FF12552
1_(407) 398-0153FloridafttaryServicexom
Revi'sed 07/15/2014
_11N. A MA&*bUCHARD
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MY COMMISSION #FF125526
(407) 398-0163 FloridallotarvService.com
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