HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: ^_� ��--�/ Permit Number. alaf03 • ID -my
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (Tn) 462-1578 Commercial Residential k
PERMIT APPUCATION FOR: To Select from dropbox, click arrow at the end of tine
Address: b 'S 1 e -rr a.CAyo ,(-t S� �2 F L
4Cl S2.
Legal Description:
Property Tax ID #: 3 �'i 1'5 ---fo 0 01 00 0 9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front
Back:
Right Side:
Left Side:
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La U Gas Tank E]Gas Piping
0 Electric 11 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ �, Gi O �, 0 0
Shutters Q Windows/Doors
Generator E, Roof Roof pitch
S Ft. of First Floor.
Utilities: O Sewer 0 Septic Building Height:
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Name
Name:
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City: "rrglt
state: 1.
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city: �,drfi e-U-Ar-J-
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Phone No. ` l) ZO 3
Zip Code: 340l 5o
Phone No. -� 7 2 q'S
Fax:
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E-Mail: Lo\,2 CAS eA��-e e-ix
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Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is 52500 or more, a RECOROEu Nonce or wmmencemert w requireu.
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DESIGNERANGINEER:
_ 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 holderto 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 1 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
commencina work or recordine vour Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Sign a of Con - or/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20 by
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(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
STATE OF FLORIDA
COUNTY OFF tr.. .
The forgoing instrument was acknowledged before me
this day of f i\A[..C..'L . 20 Z by
cylk, . - A,,,rA
(Name f person acknowledging'Ri)
at re of 146tiri Publi& State of Floriciii}
Personally Known OR Produced Identification Personally Known OR
Type of Identification Produced I Type of Identification Pniducei
Commission No.
Revised 07/15/2014
(Seal)
Commission No.
EXPIRES.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS