HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C Qq
Date: 5 - 3 - ( ( Permit Number:`� J bd u 1
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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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR®nP,QSE TOM.PROVEME;NT l_OCA,TIQN y
Address: L? �Q S l'.l h
Legal Description:
Property Tax ID#: 16 COG1- (3()0-•d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET A LE DESCRIPTION WORK
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Additional work to be 13erformed un er t is permit-check a app y:
11HVAC Gas Tank ❑Gas,Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ D� Utilities:Sewer El Septic Building Height:
01N /2ESSEEy_ C�ONCTOR:
Name G" �� Name:
Address: , �4 �Qtlr r31v Company:, A- (!• GO
city: � p 94- r l'e1rGe State:�� Address:"/ - C
Zip Code: 3419'22 Fax: City: / State:`,��
Phone No. - Zip Code: 3cf43do'_2- Fax:
E-Mail: 7 one No. — 2 .5"9
Fill in fee si le Title Hold on next page(i different E-Mail: 123 r CG , I✓X;;
from the Owner listed above) State or County License:. 2 G 1 o iF1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL C®�NSTU1C�TIO.N LLEN LAIN INFO.RMATION':
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 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 insp tion. If you intend to obtain financing, consult with lender or a attorney before
commencinR workAf recording our Notice of Commencement.
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Sign at of w Lessee/Contractor as Agent for Owner Sign ureQIro
n ra r/License Holder.
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF oaf' . Ian-L ® L COUNTY OF `� l.y C. Q
The forgoing instrument was acknowledgeol4efore me The forgoing instrument was acknowledged before me
this �-; day of M%—i 20 -1!by this 3 day of 20 4 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blic-State of Florida) (Signature of Notary Public-State of Florida)
�p
Personally Known OR P Personally Known
Type of Identification GGono2� Type of Identificat r�= °(# d922023
Y CO 15.2 c*j ;ac 19
= EXP fig;Decetnbef PIRES:December 16.2020
derv+rters =�•
Commission No. I�taryPubticUn Commission No. ed fhruNot�§��Iundetymters
�F`„�`•°Q: g ded
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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