HomeMy WebLinkAboutBuilding Permit ApplicationALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
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) 4621578 Commercial Residential
{ PERMIT APPUCATION FOR: To Select from dropbox, click arrow at the end of line I[{
Address:
Ldgal Description:
5
SI
Property Tax ID #: 3 Q n CD Q IC) Lot No.
Site Plan Name: Block No.
Project Name.,
Setbacks Front Back: Right Side: Left Side:
nn
UVAC UGas Tank [:]Gas Piping
FlElectric 0 Plumbing OSprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 4 , 6 Da WD
Shutters awindows/Doors
Generator 0 Roof. Roof pitch
S Ft, of First floor.
Utilities:I] Sewer Septic Building Height:
a
,',�.
Name "(aU LI. ti CI WL S
Name: -e
1
Address:- 5(0 5, S 1n0.(nV��cn'COY
Company:
City: P-u� Stater-
Address: � S-P- F\ IP�►1ns�s� t�-
Zip Code: q ( Fax:
City: -k- State:
Phone No.
Zip Code:Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
E Mail: A A"
from the Owner listed above)
State or County License: CAC�-c \ 9 Sc,
0
N value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
YSUP'PLER ENT INFORM'T10N�
S Y f 4
DESIGNER/ENGINEER:Y _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name.,
Name.,
Address:
Address:
City: State:
City: State:
Phone:
Zip: P• Phone -
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
CJ"-
C"-,
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 conflictwith any applicable Home Owners Assoaation rules, bylaws or and eovenantsthat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply_
Inconsideration 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
commencine work or recordine vour Notice of Commencement. _
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OFJCOUNTY OF
The ff bMaing i mentwas acknowledged before me The forgoing instrument was acknowledged before me
tl S2day of 20 �by thig-a day of . 20 , `pU by
I'MA Nlwj -
admowledgmg (Name of erson acknowledging )
(Name operson
(Signature of Notary Public- Sta of Florida) (Signature of Notary Publio- State o lon
Personally Known E' row A IWA. " nrien _ _ Personally Known OR Produced Identification
Type of Identification Pr d -•: LASHAUUA MIWAII. y{s_ Type of Identification Produced
r . sq MY COMMISSION # GG 215060 r �y •••., LASHAHNA IN
Commission No. _ roc EXPteoember20, 2022 Commission N �, �:A GW1�6RA�NINC
v , _ `. ••' oonded 1hv Notary PU* UadeWJJ0re '•,�: MY COMMISSION # GO 27506t
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS