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 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 't)'r-
Legal Description:
Property Tax ID #: ablA - '� Lot No.
Site Plan Name: 0-c \ Block No.
Project Name:
Setbacks Front Back: Right Side
11HVAC
1-1 Electric
Left Side:
�b It-, ekA%e'
LJ Shutters
Plumbing Sprinklers 1:1 Generator Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ') a O. 06
5 Ft. of First Floor: _
Utilities:LSewer Septic
Windows/Doors
Roof
Building Height:
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Name w 'Mzj± _
Name:
Company: 1 LkZ5k
WY J Lk
Address: 224 D' P S�Ce�-
Address:
City:- p-i -k 2\�(C State:-17L•
Zip Coder �i t1') Fax:
City:
State:_L.
Phone No. i9 r - g
Zip Code: bLj9 j S Fax:1101
Phone No. Y) L- q (k- I 6Ci
�1 (a j,..- I C65
E-Mail: C_AO�12jet'r,�- C,90S . C bCa
Fill in fee simple Title Holder on next page ( if different
E-Mail: tip Um
from the Owner listed above)
State or County License:
It value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
LW �Q tSTRI,J� ,LIEN LAB'' FC t tIATI
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
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 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
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,
accessary 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.
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF S`�-Lve �T
STATE OF FLORIDA
COUNTY OF J- --
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this JL day of a 20`by
this day of Z7v 24 lby
Name of person making statement
Name of person making statement
Personally Known !f OR Produced Identification
Personally Known 1. OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
{Signature of Not-stajym ri��]rR orlu
My GOMMISgg�pp GG055263
Commission No. : ; IRES Oecambgr 20, 2420
{Signature of Nota P-W tat
C > �. TtaarrA�
CC MY COMMf
Commission No. •, PIRES �mti G 25220
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE. FL 34982
772-462-1553
FAX 772-462-1578
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
Permit
Credit Card Users: 1.5% Surcharge added per transaction.
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Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA MASTERCARD
Credit Card Number
Expiration Date M _-- Zip Code
3 digit security code
Amount _..:�_....._p,,._. _ �_ + 1.5% surcharge
Business Name: U Y1 f
Authorized Signature:
Print Name:__ --
Phone: --
Fax:
Comments: b
SLCPDSD Revised 4/01/2010 EN
F'Ort Pierce Utz j i.ti.,
206 S 6th Street
Fort Pierce, FL 34950
Telephone No. (772) 466-1600
05/11/19 10.07AM
Receipt #: 009190611000002
Customer 257566
Location #: 10007903
For: CAROL J DOST
Payment Received: 290.00
Amount Tendered - Credit Card: 290.00
Authorization Number : 011191
Payment will be posted: 06-11-2019
Register, CASHIERS
Thank you - Have a nice day._
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