HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
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PERMI i APPLICATION FOR:
PROPOSED O ` _
Address: e4lct'a Cik
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Legal Descriotion:
Property Tax ID#: �Ll� �c�f7�i-C73 �i-Urno'
Lot No./
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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A-ddrtiona wor o e pe orme unclertnis permit- Oec a a appy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters--16ndows/Doors
— Electric _ Plumbing _Sprinklers _ Generator — Roof
Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor
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Address: / l,(% C Q Company:
City: 17 State: AddrPcc
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Phone No. e1,44 Zip Code: C- Fax:
E -Mail: Phone No -
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Fill in fee simple Title Holder on next page ( if different E -Mail
from the Owner listed above; State or County License
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raizm3; I Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable 1 BONDING COMPANY: _Not Applicable
Name,
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Name:
AYo-'el:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
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
+. rt,v t#rany aoolicable++ome Owners Association rules, bylaws or and covenantsthat may restrict or prohibit such
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„a...,it i am hprohvai+ that i will. in all resoects, perfon^. the v:ork
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 faRure 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
t. nt,._in. finanr ins i nm ilt-with lender or an attorney before
STATE OF FLORIDA i STATE OF FLORIDA
COUNTV OF S _ COUNTY OF � � ✓ C/ C�
M^�m,u�r was arib•iowied?e6 before me Thelogaing nst�;.^:e': uasack^rx+;3 ^::^!r•a •^'=
this day of P'�I L 26 /5 by I this It day of n n sic 26 �� or
�/)IL CQnaaid,,
of person
Personally Known OR Produced Identification
Type of Identification
Produced n�1 �Q b 1-1 f f')
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(Name of pe rs n ac o I Ing)
(Signature U1 NULafy r u0"C- She LT tiEri6H .1
Personally Known OR Produced Identification
Type of Identification
Produced P _J ✓er li e e Hoc .
Commission No.-�)eef^,-e9 / 74-4 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
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