HomeMy WebLinkAboutBuilding Permit Application 11-13-170 . ..a
ALL APPLICABT INFO rUST BBE COMPLETED FOR APPLICATION TO BE ACCEPTED r/
Date: Permit Number: I I l
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
Address:
Legal Description:
PropertyTax ID #: �vZ�'-_'�� �%� c. �'' r�?`7� " Lot No.
Site Plan Name: `7l Plv/%i Block No.
Project Name:
Setbacks Front Back:
Right Side:
Left Side:
(Yr4;L/Yw�«/ 167,a
iaitionai worK to Dje
11HVAC
nerrormea
L_
_I Gas Tank
unaer tnis permit— cnecK ail
❑Gas Piping
apply:
_ Shutters
❑. Windows/Doors
11 Electric
0 Plumbing
Sprinklers
E] Generator
0 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 64 �G
S Ft. of First Floor: _
Utilities:Sewer Septic
..
City:��`ff /.i
Phone No.—
i,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Building Height:
Namey
Compa)y:
Address: fi/s/
City: &�e,Si4 /gar l Pic.[ A State: —
Zip Code:, ?w// Fax: 5v/- %1/S" 6, 0,2
Phone No. "' /- //�
E-Mail: N;k,, Y� d02''O/ �,ed '1617/S14C4 . r6Ll
State or County License: ":?, 9 '?, I (-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: I ),r\O
Cry
_
Name:
Address: , •rh
pt
Address:
City:Q toix( _ f
State: ,C
City: State:
Zip: � '7LX) 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.
_`Signature of Owner/
STATE OF FLO
COUNTY OF
The r inginstr a acknowledged before me
thi day of VA 20 [tby
Name of erson acknowedging )
LA.
(Signature of Notary Public- StatE& Florida )
Personally Known i a
Type of Identification Pr uaA Notary Public State of Florida
STATE OF FLORIDA-
COUNTY OF :— \
The forgoing instrument was acknowledged before me
Personally Known lX OROroduced Identification
Type of Identification Produced
Commission No. . �� �'` My C m ion GG 092440 � Commission No.
Expl
CHARNIKA JOHNSON
Revised 07/15/2014 "» • Commission # FF 93C'7
�N9 ,F oaac My Comm. Expires Oct 26, 2019
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