HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O Permit Number: /' 0>6�7
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RECEIVED
Building Permit Applicatio JUL
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 �}
Phone: (772)462-1553 Fax: (772)462-1578 Commercial S1C»Ile (—&/n ,ty, FL.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 2 7 0 c�4 1 -A (fZe-p4 41,e/. "-,71STC -ze
Legal Description: LA a Wood 110► c K (A n
Property Tax I D#: Z 3`>/— Lot No. 0
Site Plan Name: Block No.
Project Name: /I/IA
Setbacks Front Back: Right Side: Left Side:
�C) afa r
Additional work to be performed un er t is permit—check a appy:
HVAC Gas Tank E]Gas Piping LA Shutters . Q Windows/Doors
Electric 0 Plumbing Sprinklers _Generator Roof
Total Sq. Ft of Construction: ` Sq. Ft.of First Floor:
Cost of Construction: Utilities: Sewer Septic Building Height: ,9 C'S
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Name :, Name:
Address: Z f 3 G��%l A :G�� f1`vr� Company 'Cc7u✓i.;P;,j
City:_ T. c=G"�L c ` ,;State:�� Address
Zip Code: 3��9!�/ Fax: �/� City: el!C 4 State:
Phone No. '7 7,2 a V/ D.f,; Zip Code: f Tz6r Fax: `7,7?-
E-Mail: A,,14 Phone No._2, ,2-
Fill in fee simple Title Holder on next page(if different E-Mail: 7-0,k" c0i_l
from the Owner listed above) State or County License: e-6 7//�—/S 0cF
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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: of Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permlt.
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 t 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 recordin4 our Notice of'Commencement.
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_Signature of Owner/Lessee/Agent igna ure of Contra r/Lic nse Holder
STATE OF FLORIDAA STATE OF FLORID
COUNTY OF COUNTY OF `
The forgoing in Fent was acknowledged-be ore me The forgoing instr ent was acknowledged before me
this�day o 20 r by this&day of 20��: by
Name of person acknowledging) ( ame of person acknowledging)
(Signature of Notary Itc-State of Florida) (Signature o Not Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produc d t
Type of Identification Produced Type of Identi
IypIZEY S.1{IyNIPNRE ° Y � MY COMMiSStON#GG 300817
Commission No. :,.� Yp.;, YCOMI �N#GG3o081i Commission ;* :*= S:March�§,
:*e $;pA3rch ti,2023 ''fFOFa;°` Bonded Thru Notary Public Underwriters
EXPIRB pubxicUnderwritess
'Revised 07/15/20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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