HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
e
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 � f
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential �y
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: /a7 -7'-f N Id M%
Legal Description:
Property Tax ID#: 144 -io11"Odo-9 Lot No.
Site Plan Name:
Block No.
Project Name: L Coy
Setbacks Front Back: Right Side: Left Side:
bETAI E OE CRI .TtC?fl DI=11 f71 C:
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1► Mrb9 r+�Y POS FOK C0N9TPtCTa,AJ%
is perms -check all t= appy:
HVAC Gas Tank Das Piping _ Shutters a Windows/Doors
[Nlectric Plumbing Sprinklers 13 Generator Roof �� Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 500. 0.co Utilities: D Sewer E] Septic Building Height:
Name j"IS' XY
Address: IN RFAJAJS'VLV,1W1,J AIIE T�
City: g RyN MAS - State: P
Zip Code: )1 U 10 _ Fax:
Phone No. --61 1-
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: % AM0$?1
Com pang: A eco,c
Address: _71 3 G�111a7�1 Pi -
city: fORT S -r I_UCiF_ State: FL
Zip Code: 4` S -a Fax:
Phone No._ 7701- -370--S%5_
E -Mail:. cryi- 7E F_I.F__C.l Klr P.9L @_007100K, C01"I
State or County License: 6C03037 7a
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
certifya 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 rales, 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 pians, the Florida Building Codes and 5t. 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
commenc- work recording our Notice of Commencement.
Signature of Omer/ Lessee/Contractor as Agent for Owner Signature of
STATE OF FLORIDA > STATE CCF FLORIDA ,
COUNTY OF , ,; _ COUNTY OF
The forgoing instrumen w acknowledged before me
this _,L day of 20by
Name of pers macng statement
Personally KnownOR Produced identification
Type of Identification
Folder
The forgoing instrument as cknowledged before me
this // day of 20/ by
Name of person makifiLfstatement
Personally Known calt Produced Identification
Type of Identification
Produced
(Signature of Notary Public- Stat w C• Y% �e'i (Signature of Nota Public- 5ta r
r (Ea
�`� ; •�y�MISSIp`h.G!/`�� Notary •*y� o••`'�143�'�����1�'��.
Commission No. �fi ;� ' 0�` Ip •. <;
Commission No.
• � p � �_ 7f ��� caQ'� .
�Z � �'•� Vii � s � 1'�.
9 ••?� w3 ;
REVIEWS FRONT �� •�6ticun t$OR PLANS VEGETATIQN SPS •b ���
COUNTER RE1„STA. �o W REVIEW REVIEW 1'r�'4v1
DATE
COMPLETED
Rev. 8/2/27
-
DESIGNER/ENGINEER: `Not Applicable -
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State;
Zip: Phone
city: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: : Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do tha w,lDrk- nn,i -'-A'7 A'7 t A
certifya 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 rales, 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 pians, the Florida Building Codes and 5t. 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
commenc- work recording our Notice of Commencement.
Signature of Omer/ Lessee/Contractor as Agent for Owner Signature of
STATE OF FLORIDA > STATE CCF FLORIDA ,
COUNTY OF , ,; _ COUNTY OF
The forgoing instrumen w acknowledged before me
this _,L day of 20by
Name of pers macng statement
Personally KnownOR Produced identification
Type of Identification
Folder
The forgoing instrument as cknowledged before me
this // day of 20/ by
Name of person makifiLfstatement
Personally Known calt Produced Identification
Type of Identification
Produced
(Signature of Notary Public- Stat w C• Y% �e'i (Signature of Nota Public- 5ta r
r (Ea
�`� ; •�y�MISSIp`h.G!/`�� Notary •*y� o••`'�143�'�����1�'��.
Commission No. �fi ;� ' 0�` Ip •. <;
Commission No.
• � p � �_ 7f ��� caQ'� .
�Z � �'•� Vii � s � 1'�.
9 ••?� w3 ;
REVIEWS FRONT �� •�6ticun t$OR PLANS VEGETATIQN SPS •b ���
COUNTER RE1„STA. �o W REVIEW REVIEW 1'r�'4v1
DATE
COMPLETED
Rev. 8/2/27