HomeMy WebLinkAboutBuilding Permit ApplicationIN �\ 11
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �-'C _
Date: 1 ' �� Permit Number: �� I
Building Permit Application JUL 7 20f?
Planning and Development Services PEM111171FIG
Building and Code Regulation Division St. Lucie C OUnt F
2300 Virginia Avenue, Fort Pierce FL 34982 Y, L
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 91
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �%p- w r I
Address:
Legal Description:
Property Tax ID #: I 1
Site Plan Name:
Project Name:
Setbacks Front Back:
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Right Side: Left Side:
WaW7L4'-'*U_
Lot No.
Block No.
Haamonai worK to njeperrormea
E1HVAC L Gas Tank
under this permit— check all
Gas Piping
apply:
Shutters
a
_J
_
Windows/Doors
11
Electric
0
Plumbing
Sprinklers
Elenerator
E]
Roof
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities
:Sewer Septic
Name v Uz✓
Name:
Address: ///
Company:
City: State:
Address:
Zip Code: Fax:
, City: w
Phone No.
Zip Code:
E-Mail:
Phone No. 6_ —7-.
Fill in fee simple Title Holder on next page ( if different
E-Mail: /�,L'/ll� tO
from the Owner listed above)
State or County License:i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Building Height:
Fax:
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DESIG
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE H _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY•
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
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.
s
_ Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FL DA � QM
STATE OF FLORCOUNTY OF t� COUNTYOF
The fo going in tr en was acknowledged efore me
his tday o 20 ° by
(Name of person
of Notary Publidj State of Florida )
Personal) l(nown " "'Off P " b Z'aTi
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Type of Iden 'jicatio Pror�
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Commission No. gP!�0!dd° �S°1Iq" { qN ' i,he
Revised 07/15/2014
The f r oing in'stpAnent was acknowledged before me
f"A.a o 20,I- by
(Name of person
(Signa ure of Notary Public- ate of Florida )
Personally nown
OR Produced Identification
Type of Identificatio
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SEA TURTLE
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REVIEW
DATE
COMPLETE
INITIALS