HomeMy WebLinkAboutBuilding Permit Application� J ,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - g— ) t" Permit Number: �� �S- C) .
RECEV, n .
Building Permit Application ,pp
Planning and Development Services MAYA O Z'9116
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Y Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
3yCJ 737
Legal Description: \4.\\1AGS
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Property Tax ID #:�^��"'��a — ��`Z'®d��-1—G"�7►�1^S Lot No. ZS
Site Plan Name: Block No. 2
Project Name:
Setbacks Front �2t Back: �� �` Right Side:' Left Side: I8t
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unoertnis oermit—
HVAC _Gas Tank Gas Piping ;}:=;`, Shytters
ElectricPlumbing Sprinklers
"Generator
Total Sq,."Ft`of Construction:_ S . Ft. of First FI o
Cost of Construction: $,d� ci , D Utilities: LZN Sewer,
Windows/Doors
ing Height:_
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Name 34Lm,..1 �.��l.I D� �Ll1� ("�`R�
Name: ' swip t-A C5. k'ENoi:y c Q
Address:
Company: `%1Sk_ 0:1\ 2'�''�?VG�1�71.1, C�
City:. h.l ® Ste
Address: '5°G3 X1\`�I �t\\MpCr^Do`F�1L'y�
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Zip Code:
City: �cm 57 t:VC\t State:��
�1Fax:
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Zip Code: `6N9a 3 Fax:
Phone No. �� -
E-Mail:
Phone No. (SCu\, �4 Coy \34Cn
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License: �'C'tiC'_- (`%2�i'�°�i✓a
if value of construction is 5z500 or more, a KLLUKUtU IVoiice OT WIIIJIMfll.cfl1anL'o 1 cyuu—
DE ENGINEER: — Not Applicable
Name:-VCC
Address• Ache, \3`
City: L —rDyuh State:_
Zip: 33AG02 Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip. Phone: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 your Notice of Commencement.
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Signat a of Owner/ Agent/ Lessignatur ontractor ense Htlprr
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STATE OF FLORIDA - ° 5 t2 STATE OF FLORIDA
COUNTY OF _ COUNTY OF
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The forgoing instrument was acknowledged efore m $a The forgoing instrument was acknowledged before m a � g
1 F. >-w this day of I� 20 by M # 2
this day of r 20 by v� = o a
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mtu
ern , : _ —F.
(Name f person acknowledging) v.... t� (Name o person acknowledging) ¢ �w
2AI,
(Signature of Not Public- State of Florida (Signature of N t ry Public- State of Florida)
Personally Known .1�011 Produced Identification Personally Known _� OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
1
INITIALS