Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAboutbuidling permitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
tau nr�rr
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation'Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial
Residential
To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal,Description:r 1��(j
Property Tax lD #: Lot No._�_
Site Plan Name: Block No.
Project Name: C
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUC ION IN ORMATION:
ona wor to e e orme under this permit — c ec a I apply:
TIq
AC 1:1Gas Tank Gas Piping _ Shutters L�_.1 Windows/Doors
11 Electric 1._1 Plumbing Sprinklers � Generator � Roof Roof pitch
Total Sq. Ft of Construction: �-- S Ft. of First Floor:
Cost of Construction: $ J utilities:tSewer DSeptic Building Height:
OWNER/LESSEE: — CONTRACTOR: f
Name
City:\C��_VUA� 1-3 State' ��
Zip Code: 3 Fax-.
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: J V -TA I — `LAA A '-S
Company:
Address:
City: `,��—(1 l} Stater
Zip Code: Fax:
Phone No.
I_ -Mail: -
State or County License: 1"t�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Add ress:
City:
Zip:
Phone:
T Not Applicable I MORTGAGE COMPANY: r Not Applicable
Name:
State;
Address:
City: _ State:,
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name. _
Address: Address: T
City: City: T
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: ur failure to Record a Notice of Commencement may result in your paying twice for
improvements to your operty. A Notice of Commencement must be re orded and posted on the jobsite
before the first ins tt n. if you intend to obtain financing, consult wO fender or an attorney before
commencing wor r ecordinR your Notice of Commencement)
Signature
as Agent for Owner
tense Bolder
STATE ©F FLOPIU4
STATE OF FLQ A
COUNTY OF COUNTY OF__
The for Ding instrument was acknowledge before me
this J5day of }f OJ��.rl� 20 Jqby
(Name of person acknowledgigg4--,
(§Anature of NofgryJpublic-St
rsonally Known R
Type of Identification Produ •ei
Commission No. a'`.t4"�"•
Revised 07/15/20
of Florida )
Ito
The forgoing instrument was acknowledged before me
this day of 20 by
_-An
_ C� �-
(Name of person acknowledging )
Pu&r- State of Florida )
Personally Known OR Produced Identificatio
Type of ldentifi a ion Produced
��}tRYti R 5421
Commission NoCol . •"�.. "•• �isss�� � 11,2�i9��
a= ie5 'IpVem
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS