HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
a x
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3498,2
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: T OL4 'Ac,,iI
Legal Description:
K r 0 cf
Property Tax ID #: �- `5co�� —U Lot No.
Site Plan Name: i� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormea una r t
Mechanical — Gas Tank
Electric ^ Plumbing
Total Sq. Ft of Construction: f
Cost of Construction: 3 c a d
permit — cnec
Gas Piping
Sprinklers
& V1
apply:
Shutters
Generator
Sq. Ft. of First Floor:
Utilities: Sewer Septic
Name l/ I Cc9le- I JC V " 1
� t;
y y Gt '
,
Address: � ��i 6 f ✓ V Lei -
City: i VC-e- State: F
Zip Code: J Fax: r�
Phone No. 4_4—
F-Mail:
Fill in fee sire le Title Holder on ne page ( if different
from the Owner listed above)
Windows/Doors
Roof Pitch
Building Height:
If value of construction is 25r more, � RECORDED Notice of Commencement is required.
Address: T OL4 'Ac,,iI
Legal Description:
K r 0 cf
Property Tax ID #: �- `5co�� —U Lot No.
Site Plan Name: i� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormea una r t
Mechanical — Gas Tank
Electric ^ Plumbing
Total Sq. Ft of Construction: f
Cost of Construction: 3 c a d
permit — cnec
Gas Piping
Sprinklers
& V1
apply:
Shutters
Generator
Sq. Ft. of First Floor:
Utilities: Sewer Septic
Name l/ I Cc9le- I JC V " 1
� t;
y y Gt '
,
Address: � ��i 6 f ✓ V Lei -
City: i VC-e- State: F
Zip Code: J Fax: r�
Phone No. 4_4—
F-Mail:
Fill in fee sire le Title Holder on ne page ( if different
from the Owner listed above)
Windows/Doors
Roof Pitch
Building Height:
If value of construction is 25r more, � RECORDED Notice of Commencement is required.
0'.
k,4}'t�7,_
DESIGNER ENGINEER: of Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER! „_ riot Ap a
BONDING CO Y:
—Not Applicable
Marne:
me
e
Address:
City:
City:
Zip: e:
Zip: Phone:
OWNER/ CONTRACTOR AFFi : A)plication is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or insta on has ca menced prior to the issuance of a permit.
St. Lucie Counttyy mak o representation ti at is granting a permit will authorize the permit holder to build the subject structure
which is in conflict ith any applicable Home Owners Association rules, bylaws or and covenants that mestrict or prohibit such
ay r
structure. Please consult with your Home O1vners 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 iFlorida Building Codes and St. Lucie County Amendments.
The fallowing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fenc Ids, 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 N'Iotice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consul ith lender or an attorney before
commencimiz work or recording your Notice of Commencement.
signature of Owner/ Less ontractor as'
Agent for Ow
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
couNTY OF - �V
C, _
COUNTY OF
The forgoing instrurinent was acknowledged
110 day � t 20
before me
I by
The forgoing instrument was ;Acknowledged efore me
this i b day of -i i.� 24 by '.
this of
,
PCJ
(Name of person acknowledging)
r
(Name of person acknowledging)
(Signature of Notary Public- State of FlorLientification
{Signature of Notary Public- State ofi orida )
Personally Known ✓ OR Produced
Personally Known -"— OR Produced Identification
Type of Identification
Type of Identification
Produced CHARLOTTE:,
M. wALTERS
Produced MM`TEM. Wa! 7ERs
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