HomeMy WebLinkAboutBuilding Permit Applicationimal-) &X�
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
019M
W 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
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Address: -C/.2-/
Legal DescriptioKAW
Property Tax ID #: Lot No. (5-
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Site Plan Name: Block No.
Project Name:
Setbacks Fronta Back: Right Side: Left Side:
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Additional worKto be ertormea under this permit - check all apply:
11HVAC Gas Tank E]Gas Piping Shutters 11 Windows/Doors
11 Electric 0 Plumbing Sprinklers EGenerator D Roof
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: $ 1300,00 Utilities:Cn Sewer ElSeptic Building Height:
Name: 6wf
Name( -,awnt-z (_,CS-P a It,-;
.Address: 1760 /V. u�
Company: It h 1) 4
City:
Address:
Zip Code: Fax*
City: State:,
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Phone No.
Zip Code: . &/// /_
C-2 Fax:
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Phone No. (rD% Wel_
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License: .11LU/0
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
PEW=
DESIGNJER/ENGINEEq: Not Ap able
RIP
MORTGAGE COMPANY: Not Applicable
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Name:
Addr IA —A
Address:
City: t Y_ L IL 0- f"' State: �)Cj'_
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 ancovenants 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 your Notice of Commencement.
Signature of Owner/ Lessee/Agent
_s
Signature of Contractor/License Holder
STATE OF FLORIDA
&a
STATE OF FLORIDA
&-.&-
COUNTY OF
COUNTY OF
The! fgrgoing instrpment was acknowledged before me
/An
th A of 20 Llby
The formning instrum!eAt was acknowledgeme
this 20
1,71L�&
.2clay
g (Nam of person acknowledgirif )
(Nam oTperson ackrIbMedg6g)
(Signature of Notary Pubric-- St0+.6 of Florida)
(Signet dr=allot PU61-1c- Sta of Flori a)
Personally Known OR Produced Identification
Personally Known OR Produced I _n fication
Pros
Type of Identification Pro
Type
Type of Identification ProWc ON 04 04
No
Notary Pubw State of Floriati
r
NA)Donza Commission No.
my'lommiasion
Notary Pub S of Florida
No. . . . . . . . . . . .
F rances
GG 092440
oFno Expires 07127t2021
My Comitilesion 00 092440
t I J I I
Expires 07127/2021
f, 0% OWN
Revised 07/15/2014
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