HomeMy WebLinkAboutBuilding Permit AppALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
IPFRIVIIT APPLICATION FOR:
To Select from dropbox, click arrow at the end of line �
PROPOSED IMPROVEMFNT LQCATIORI.�
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Address: -?�[�� ��S�J��i� C'P'CE
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Legal Description:XES E Ay-, �K&E K A e-C7L- Lo
Property Tax ID #:: .3-32-2-- Lot No.
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Site Plan Name: /J a V Block No.
Project Name: 1U14 V A Re TTA}
Setbacks Front Back: _ Right Side: Left Side:
- A15 _51 61,Ll3J C#�LON OF WORK: N -y
C h ,U)& C� OU -r- 3 N p Q 'I Z_�C, IU G L
�ONSTRUCTII NaN 0' RMATION
Additional work to beoej Orme under this permit - check a appy:
HVAC FJ Gas Tank Gas Piping _Shutters Windows Doors
❑ /
❑ Electric ❑ Plumbing Sprinklers Generator a Roof
Total Sq. Ft of Construction: _ S Ft. of First Floor:
11
Cost of Construction: $ L/0 ((. % Utilities: Sewer Septic Building Height:
CLaI/URLESSI=EACTOR -
- ;-CONTR
- - ..Name.-
of
Name aE-PHE� Iy^AYARE-T_fi_ 5AxQj
Address: _7309 X6�S�&JC R F 2 Company:, IOd.t bu`t't a tiJ
City: nA,T St. LA C % — State: Address: J I -i iv -79 -1-1-1
Zip Code:3 L{ e Fax: Cit -
Y� W . 'Pb.\,rY� �t c', C• L � State: F
Phone No. % i .359 �a2 Zip Code: 35L4 1 a- Fax: t L, f '�37`>
E -Mail: Phone No. nsl -�y5a= Zei5
Fill in fee simple Title Holder on next page ( if different E -Mail:
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
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
R►
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
State:
Not Applicable
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 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
commenck work or recorgUM your Notice of Commencement.
_ Signature of Over/ Lessee/Agent
re of Contractor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF COUNTY OF gr -IL en Qc'ork
The forgoing instrument was cknowledged before me The forgoing instrument was acknowledged before me
thi�%day of 2Q,?c7 by this DOday of Ap �� , t 20 2Q by
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(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced s •�
L A '
/ z`, •-. Notary Pubiic - Stzt
4
Commission No. 45e ov � I Commission „ GI
'f Oc� ` My Comm. Expires l
_ Bonded throueh Natioral
Revised 07/15/2014
REVIEWS
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(Signa! e of NQk&y
State of Florida )
Personally Known
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Produced Identification
entification
Produced
IN
Florida
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9M{nis on No.
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g 23, 2022
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