HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
q�JDate: - Ip• Permit Number: /
Building Permit Application
Planning and Development Services MAR 16 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ��
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential �1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line C '
PROP®SED I'M"@R_M EII - . LOCATION:
Address: -
gal Description:•-t-'
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Property Tax ID#: 3L� OA- I-Pj � y,--, O (pDCS, Lot No.
Site Plan Name: 0,);70)( lotPA LA,L Block No.
Project Name: r '
Setbacks Front 1 Back: �' Right Side: 3 y Left Sider
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Additional work to be rtormed under this permit-check all appy:
❑HVACGas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ PlumbingSprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First,Floor:
Cost of Construction:$ �`���� o 'V' Utilities: Sewer Septic Building.Height.
O,WNERf.E SERE; C®NTRACTOR:
Name Name: ' ,�nh`n00
Address: O I Company: \ No
City: I StJtO sz State:� Address: U1L.
Zip Code:a 4 92 2 Fax: City: State:
Phone No. Zip Code:29QR2 Fax:-7-7.q 4(95=,3R&t7
E-Mail: Phone No. 1(s `l - Lfo.517 Ib
Fill in fee simple Title Holder on next page(if different E-Mail: -R PAgua COJI3 052.',4,
from the Owner listed above) State or County License: 104 3`in
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not 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
commeWng work or recording our Notice of Commencement.
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Signat re of Owner/Lessee/Contractor as Age wner Sign ure of Contracrorfucense Holder
STATE OF FLORIDAr (
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COUNTY OFCOUNTY OF (if,{
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this& day of ,� 20 4: y this day of t•SZb 20 by
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(Name of person ac nowledging) (Name oferson acknowledg ng)
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ig ature of Notary P lic-State of r1oricla ) (Signature of Notary ublic-State of Florida) J
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification v
Type of Identification Produced Type of Identification Produced D
Commission No. g (Seal) Commission No. `� (Seal)
Revised 07/15/20 �,, SANDR-1A ACEr S
oa�JT;'p°y� Notary Public,State of Florida �a fpUw i SAN n LyfJits t'lt E6tS
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DATE
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INITIALS