HomeMy WebLinkAboutBuilding Permit ApplicationPlanning 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 x
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Legal Description:
Lot No. Property Tax ID #:
Site Plan Name: fliôa- 4aLJa Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
Sp 1/ ?/(-c
UgflL2J?S-Q4&-i Ou,t
na war to 0 e De orme
AC JGas Tank
Electric 11111 Plumbing
unsert is permit — c ec
[]Gas Piping
[1 Sprinklers
- Shutters Windows/Doors
[ii Generator U Roof Roof pitch
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
S. Ft of First Floor:
Cost of Construction: $ _5Z. OT3 Utili tiesioSewerF-]Septic Building Height:
Total Sq. Ft of Construction:
IME
Name &D
Address: .:3 %T S .Pi
City: G QJ1Qp
lc-eM. Ot
StateL
Zip Code: 3 '-1-q (?D Fax:
Name: Qt€ri r-1-(i-
Phone No. 1m2- -4(LLt-- 3'r-c
E-Mail:
Fill in fee simple Title Holder on next page (If different
from the Owner listed above)
Company: 41-fiAMdYkO N6Qk A40-
Address:
4-/C
Address: /l1O /'lLIJ 4) St
City: State:
Zip Code: 33ti Fax:
Phone No. q
E-Mail: )' COSMb-1;Pe
ll-6-5-3
4 r, Pon
or County License: &- J
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Commission N
ue)1\
(Name if , -rson acknowled
ry Pu 'c- State of Florida)
(Name of per n acknowledging)
ublicate of Florida)
Personally Kn.w
-e of IdentifiRl.
I OR Produced Iden
tion Produced
Personally Known OR Produced ldentifica
of Identifica n Produced
on
Revised 0 7/1 14
Commission No.
N " T
RAFF
DESIGNER/ENGINEER: Not Applicable - MORTGAGE COMPANY:
Name:
Not Applicable
Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable BONDING COMPANY:
Name:
Not Applicable
-
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 prop rty. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspectio you intend to obtain financing, consult with lender or an attorney before
commencing worr- rdin: our Notice of Commencement.
Signature o Ow7AP,- ontractor as Agent for Owner
STATE OF FLORIIA
COUNTY OF
The forgoing instrument as acknowledged Vlefore me
thi day of SLLLJ , 20 /by
Signature.rntor/License Holder
STATE OF FLORtyJaJ,/ COUNTY OF
The forgoing instrffi.entyas acknowledged before me
this c95day of ~)C_,L lLj , 20/ ffby
REVIEWS
COUNTER
FRONT ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW DATE
COMPLETE
INITIALS