HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE 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) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
t• +ate. X+{ -
f.
Address: % U �t�l� l r^ C 0,' �Y_
Legal Description: "/ICJ_ j —` j�U �C1 %�
Property Tax ID #: ��� ---- � CJ C....J 'Zj'j ��Ty
�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
y
'34,
I
,+n. }�C`.; +r�a4'�. n_,-a: .... ;`�;,=v.•.>-.'.',a<k t. . .1
W
e-., _ y. e, .x.
Additior workto a pe orme un er tlis permit - check all that apply:
Mechanical _ Ga ank _Gas Piping _Shutters _ Windows/Doors
— Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
Name i % riskllo
Name:
Add c- Urj, 6 fl ka
Compan ,, 1 rY7 ;
City: bar _ State: F,"^
Address: f'
Zip Cod��, Fax:
City: State: f::z—
Phone No. 7Z? — --
Zip 13 y9_'_0L—
Code: ; Fax:
E-M /- %0 erg
Phone No .2 -- -- 6 Ze�l
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County Lice se ('!�C
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU ION LIEN LAW INFORMATION:
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:
OWNER/ CONTRACTOR AFFIDVITi Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has 4ommenced prior to the issuance of a permit.
St. Lucie Count, makes no representation that is granting a permit will authorize the permit holder to build the subject structure
is
which 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOURLENDEROR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as gfi nt far Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF c;.
STATE OF FLORIDA I
COUNTY OF ��1G1 e
><iCie,
The forgoing instruTem. was acknowledge before me
The forgoing instr ent was acknowledged before me
this A& day of ` i 'v5 2� `Z by
this � day of �tl.�i 20,Q1 by
y1 L
' �i /r
Name of person making statement.
Name of person making stg1tement.
Personally Known 1 OR Produce
Idemtification
Personally Known Produced Identification i
Type of Identification'-
——OR
Type of Identification
Produced
Produced
(Signatir re of Notary Public- St
nature of Notary Public- State of
,t Est tyr
0
�� l�r'
Commission No. .;„� 1
,rotary PuCf;c State & Flom
&a L Bu«efiefd
(5�j mmsaion GG 302055
,� � � F. ` -�,
�r i `� e aca Bc xe
C mission No. 10_h j` 1 ea
.1
Farr.Q
_x�res02Jt4t2023
r}a:nu t
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW
—
-
REVIEW
REVIEW
--
REVIEW
REVIEW i REVIEW
{
DATE
1
IE
RECEIVED
DATE
COMPLETED
--
i l
—�
Rev. 2j7/1.9
__ ..