HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ll tom,
Date: Permit Number: Q3_1q
Building Permit Applicatipril
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
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Address:
Legal Description: ch a
Property Tax ID #: 46-ba.-too I. oo-n-ow Lot No.
Site Plan Name: Block No.
Project Name: S.!ZA ri YNA
Setbacks Front Back: Right Side: Left Side:
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Additional wor( to enertormed under this permit -check all apply:
1jHVAC Gas Tank F]Gas Piping m_Shutters Windows/Doors
[]_ Electric 0 Plumbing OSprinklers D Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 14 6 ST5n• zo Utilities: Sewer Septic Building Height:
7777T J
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77
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Name Name: (6
Address:q55D 5. C)C,-e4LV\ br *q0'3 Company:
J0-% "-� CLa) State: fL Address-6 _dge_�( Rd
City: emen — _CJ L A S Bg
Zip Code: Fax: City: .<-r6, n_,e-4_ State,.R-
Phone No. 71st - z54 - 9 44 15 Zip Code: 544949 Fax:
E-Mail: i ts, a inli. (Inm Phone No. - - 5
Fill in fee simple Title Holder. on next page if different E-Mail: I -
from the Owner listed above) State or-CAntyLicense:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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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 inspection. If you intend -to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
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Signatur, ofZRIDA
er/Lessee/Contractor as Agent for Owner gnatur� of Contractor/License Holder
STATE E OF FLORIDA
COUNTY OF '�)k , COUNTY OF SL
The forgoing instrument was acknowledged before me
this . day of 20 11 by
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(Namef p r oson acknowledging )
aturt4 of Notary Public- State o�Ulorida )
Personally Known _
Type of Identification P
Commission No.
Revised 07/15/2014
The for oing instrument was acknowledged before me
this—, day of 20 rJ_ by
(Name of I
rson acknowledging )
(Signature of Notary Public- State lorida )
rsonally Known
oe of Identification Pro
My Comm. Expires Dec 20, 2018
CG5�� Eton # FF 177249 Commission No.
Bonded through National Notary Assn.
Chmm. Expires Dec 20, &Mission # FF 17724 : I
Bonded through National Notary n '
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