HomeMy WebLinkAboutBuilding permit app ALL APPLIC LE INFO MUST 8E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
P.ermit,Number:
o4?- ,
Building PQrr�tit .
Planning and Development Services APPlieation,
Building and Code=liegulgtion Division'
2300 Virginia Avenue,Fort Pierce,FL 382
Phone (772)46 _1553 Fax:(772)452-1578 CO.Illr1 &cial
Residential
PERMIT APPLICATION FOR: To Select from dro
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Address`
Legal Description:
Property Tax ID#: [�
Site Pla i Name:: Lot No,.
Pr*d Name: `�� Block No.
Setbacks Front __ Back: Ri ht Side:
g Left Side:
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_ AC Gas Tank Gas Piping Shutters Windows/Doors
Electric Q Plumbing Sprinklers —Generator Roof Roof pitch
I otal'Sq.Ft of Construction: S . Ft:of First Floor:
Cost of�Construction:$ Utilities: 5ew.er F—]Septic Building Height:.
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Name U0 Name:- X 4
Address: L
Company:
City: Stater Address: :
Zip Code: Fax: City: State:
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i Phori No: Zip Code: S Fax:
E-Mail: Phone No. — � —j` L�
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Fill in fee simple Title Holder on next page(if different. E-Mail: 1 S 1 `si-Q-41to- Q 1�(F A -tr.&Vy
from the Owner listed.above) State or County License:�1��t-0S #�
if value of construction is$2500 or more,a.RECORDEQ Notice of Commencement is required.
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.DESIGNER/ENGINl EM,- Not=Applicable MORTGAGE COMPANY. _Not Applicable
Naive: Name
Address: Address
City: State. City State:
l Zip: Phone: Zip';; Phone:
FEE SIMPLE TITLEHOLDER:, Not.Applicable ,BONDING COMPANY:_ _Not Applicable'
0 .Name: Name:
Address Address:
City: City:
Phone': Zip: Phoney
I certify that no work'or installation has commenced prior to the issuance ofa permit:
St._Lucie Coun 'makes no representation that is granting a permit will authorize the.permit holder,to build the subject structure
which rs n conflict with,any applicable=Home Owners Associdion.rules,,bylaws or and covenants that,may restrict or prohibit such
structure.Please consult with Your Home Owners Association"and review yourdeed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will;in alf 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 exehipt'from undergoi`ng-a"full concurrency review:,roo'm'`additions, .
accessory structures,swimrriing.po fs,"fences;walls;signs,screen roo►r%s;and'accessory.uses.to another,non-residentiah_use
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WARNING TO OWNER:Y,olu` failure to Record ziNotice of Commencement"may result in your'paying tWice for _ '
improvements to your pro erty`:A Notice of Commencement must be recorde" nd posted on the jobsite
before the;fiest inspecti . If you intend to obtain"financing,.consult with len or an'attorney befgre `
comrrienGln wor Ordln "Our Notice Of.Commencem' t.,
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Signature w eej[ontractar"as Agent for Owner Signature o icense Holder
STATE"OF"FLORi STATE OF FLORIDA k
COUNTY OF ���� COUNTY OF
The for oing,instrument was acknowledged before me The forgoing instrument was a nowledged before,me
this day of" 20cbythis :� day of 2CL b
y
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Nam e person ack now l ) (Name of person acknowtedgin
j gna a (Sign ure of Note lic-S to of F' gEN�
G° �tae `ttiR GCi92 �ot�
Personally Kn n. 4s �. ced t ion. Personally`Kno n
e"-of Identi i >jc
Type of Identifi tion Pr
K•.. t`^ 'tom
Commission No, (Seal)
Commission No. ':�+ � � ealj"
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE; MANGROVE"t
CCIUNTER REVIEW', REVIEW REVIEW REUfEW REVIEW :.:REVL,EW
E
DATE
COMPLETE.
1NlTiALS