HomeMy WebLinkAboutBuilding permit application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: Pernj it Number:
RECEIVED JAN 17 17
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Building Permit Applicl tion
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 i Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �p
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Address: I el(
Legal Description:z3 m _�q n."`34-_1 erf u 'iq o f du tiq aisw iA6e,53 0410 't ►tw h-�L
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Property Tax lD#: d3a?-_)a a-003-o0o- S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left�Side:
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ttiona wor to e e orme un er t is permrt-c ec a app y:
❑HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers Generaltor Roof ® Roof pitch
Total Sq. Ft of Construction: S. . Ft..of First Floor: N a v
Cost of Construction:$ Utilities: Sewer Septic Building Height: I Z
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Name M6%, ( Qjft2ar1_dto. Name: f l�✓y sot✓$'lam tic �)
Address: `6K 40 tcvy� frvio, dy?,A�. Company: I cy mod^ �� ;�
City: fw---ol,uu State: �2 Address: 8t� SC Ct N c�li-.
Zip Code: 3 d`I 4-6- Fax: — City: Ss�v✓t- �
Y State: It
Phone No. Zip Code: -j 4�a Fax: -�t2-25r-`T_)Z-A4
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: PJ1 cto�.
from the Owner listed above) State or Country License: C.Gc c37b7?�-
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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: Not 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 per
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
commencing work or recording your Notice of Commencement.
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Signa ure of Owner/Lessee/Contract r as Agent for Owner g-nature of Con nse Holder
STATE OF FLORID - STATE OF FLORIDA
COUNTY OF LINTY OF 1MCA✓%h v1
The far oing ins ent was acknowledged before me =�' a'f a forgoing instrument was acknowledged before me
this day o 20/ by ��°;;,*„''t s l'1 day of )AV-\ 20 1-4 by
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a m�
i- 'rkwc,6&1,P7 t ✓�; (�
(Name of person acknowledging) !':9 ( ame of person Acknowledging)
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(Signature 61
otary Public-State of F orida) �� ignature of otary Public-State of Florida)
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Personally Known OR Produced Identification rsonally Known�OR Produced Identification
Type of Identification Produced ype of Identificati n Produced
Commission No. (Seal) Commission No., (Seal)
THERESA DE RITA
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MY COMMISSION#FF 062929
Revised07/15/2014 '� EXPIRES:October29 2017
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�` BondedThruNotaryPublicUnderwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
_ DATE
COMPLETE ,
INITIALS
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