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ALL APPLICABLE INFO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED % /��1 /
Date: [ Permit Number: _ / "/y I )
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Building Permit Application
Planning and Development Services 610Z 9I Ndf
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ed r
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: .1 '
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Frontil
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Back: " Right Side: Left Side:
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Haamonal worK to be ertormed under this permit — check a apply:
�HVAC E] Gas Tank ❑Gas Piping _ Shutters
11 Electric El Plumbing Sprinklers Generator
Lot No._
Block No.
L__L Windows/Doors
0 Roof
Total Sq. Ft of Construction: . 3 S . Ft. of First Floor: ��/� a
Cost of Construction: $ 11�8% J(P a . 20 Utilities: oSewer Septic Building Height:
roame r.o Name: ;/y
Addres ` r Company: `
City: oe&24 StateY?Zr Address:
Zip Code: /90 Fax: City:
Phone No. Zip Code: lrj///
E-Mail: 0t uo d tynw Cam Phone No. /
Fill in fee simple Title Holder on next page ( if different E-Mail:'��c��
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
State:—A!�'
Fax: 09
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DESIGNS
_Not Applicab
Name:
Address:_ /
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
rI
MORTGAGE COMPANY: _ Not Applicable
Name: J) ),L7
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 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.
� Signature of Owner/ Lessee/Agent
STATE OF FLORID
COUNTY OF�/%%JSo/—
The for oing instr nt was acknowledged fore me
thisday of 20�7by
(Name of person acknowl dging )
(Signature of Nota ublic- State 4F[orida )
Personally Known OR Produced Identification
Type of Identification Prod
1Wr �ctgffi
blic a e o
Commission No. ;� Donzalyynticsion GG 092440
n.w Expiros07f27J2021
Revised 07/15/2014
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Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing inslAryent was acknowledged efore me
this day of 20 J� by
(Name of person acknowleddng )
.(Signature of Notary P lic- State of orida )
ersonally Known R`Produced Identification
ype of Identification Produced
mission No. Notary Public $$��to (Florida
noes Donilea )
u,� a My Commission GG 092440
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