HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9- Permit Number:
461
� Building Permit Application
Planning and Development Services SEP 17 2018
Building and Code Regulation Division y
2300 Virginia Avenue,Fort Pierce FL 34982 e: .;t<4.,� i�I
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Res deia'ipl; . �,,unt,rr: 3_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description: oZ0
Property Tax ID#: of /- Lot No. _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
AJd
itiona wor to e e "orme un er t is permit-c" ec "a appy:
HVAC -Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 a
Electric 0 Plumbing Sprinklers 1:1Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$_ 0, 6 to Utilities:Sewer Septic Building Height:
Ism
Name4 Name:
Address: Company:
City: (.!/y!7 Stater- Address:
Zip Code:® 4� Fax: City: State:
Phone No. 7/�• �.�r` � Zip Code: 53411 ;Z Fax:
E-Mail: Phone No. ��!
Fill in fee simple Title Holder on next page(if different E-Mail: zt
from the Owner listed above) State or County License:
I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE CO PANY: _Not Applicable
Name: r AName:
Address:_ Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not pplicable BONDING COMP NY: _Not Applicable
Name: Name: A VIA
Address: rD Address:
City: City:
—kV-
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 thepermit 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
commencing work or recording our Notice of Commencement.
_;Oe /'-� s
nature of Owner/Le see/ gent ture of Contrac License Holdlje�e
STATE OF FLORI STATE OF FLORID
COUNTY OF COUNTY OF
The forgoing instru nt was acknowledg efore me The forgoing instrum t was acknowledged pefore me
this 4 day of 20 by this Lyday of 20 l by
41L
(Name of person ackriowl dging) ( 0ie of person acknowledging
6000 C:C�
(Signature of Notary Public-State of Florida) (Signature of otary Public-State of Florida)
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification Produced
40r°eey Notary Public State of Florida
Commission No.
Fran �ppffl1za p-''"k, Notary Public f� Florida
My Corti§Tn GG 092440 Commission No. Franoes Doriza`�
NMI�°� E-Pires 07!2712021 �¢ My Commission Oct 092440
Revised 07/15/2014
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