HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
COUNTY
0
Building Permit Application
Planning and Development Services
Building and Code Regulation Division 4' ir
2300 Virginia Avenue, Fort Pierce Ft 34982 t
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPOVE Q3TlO ,
'tt.sj Address: j '. b 1S.
Legal Description: U lkS t 1k fi ta) t, t.ce-1 C...
Property Tax ID #: 3tAaa -7Y3 -CfJJ--t{'51t.5 ..- Lot No.
Site Plan Name: Lt.J\Q.. CocrAfr\Q.fl3.JIe Block No.
Project Name: d
Setbacks Front Back: Right Side: Left Side:
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-:- GONSPU&TION I FORMATiON - 5t9&cjk
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Gas Tank []Gas Piping
-1. appy:
'Shutters L.jWindows/Doors
LI Electric [j Plumbing [isprinklers I J Generator LII] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 0 0 utiiities:sewerflseptic Building Height:
OWN DAESSEE__'7YTWM7MT~~`~- 5
Name arça (i mvvtq 4b Name: vytp'y,
Address1Ø\3.SLD tAO XYZI.X_?' 42J Company ,Q,r/jrzLct4 ! a C 4'
City: State' Address:,j387') I fluJ H St
Zip Code: Fax: City: S5LL._fl (Ai S-P State:JL
Phone No. Th'ja-(z3'a._ Lt.ôg Zip Code: 8_330 Y Fax:
E-Mail: Phone No. qst
Fill in fee simple Title Holder on next page (if different E-Mail: '..OS-Q.N'fl-Vq U V%Q. 0Ac .ç'f'\
from the Owner listed above) State or. County License: N!rQflS3 r
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
on
Personally Kn
Type of Identific
ignature of VP Pub ic- State o
Commission No.
Fl
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name:
Not Applicable
Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
PEE 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 r lure to Record a Notice of Commencement may result in your paying twice for
improvements • yo r pro 9% rty. A Notice of Commencement must be recorde .nd posted on the jobsite
before the V t insp tie f ye'-tend to obtain financing, cons - iran attorney before
commen g work o er.r.gfrNotice of Comrnenceme
yr
Signatur Contra tor/License Holder
'000!" ~~
Signature of I wne "essee/Contractor as Agent fo Owner
S
STATE .FFLOR'A
COUNTY OF t1* An
Th e for oing instrum t w s acknowIedgedefore me
this )46 day of ZLA. 13 , 20 /4_by
(Name 9f pejson acknowledging)
Commission No. (Seal)
STA E OF FLORID
COUNTY OF
The forgoing instrument r05 acknowledged b,e/ore me
this /(odayofTVit/9 ,201Y'by
(Name of .erson acknowledging)
AAAWIM& -A
Revised 07/15/2014
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS