HomeMy WebLinkAboutBuilding Permit Applicationr
ALL APPLICABLEINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: g ] 6 l II Permit Number:
RECEIVED AUG 021017
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:�.iG�
Legal Description: Sivrncud LO:Z, f 5 Cor 3437,7-
Property Tax ID #: �V1a5"1 a3� �dSd �aad� a Lot No.
Site Plan Name: Block No.
Project Name: �rP�isfD"L�i fhi�C�y!✓
Setbacks Front Back: Right Side: Left Side:
❑ HVAC
MElectric
❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $��®�
LJ Shutters
Generator
S Ft. of First Floor:_
Utilities:n Sewer 0 Septic
P.
Windows/Doors
Roof Roof pitch
Building Height:
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Y.41+i�KS'F1.$'9F $.,:�:¢4T�����i'in'""y
Name ��
Name: v_a;41—
Address: ,. g /E �
Company:
City: State: ,4-'/�
Address:
Zip Code: Fax:
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City: ��� S to:�
Phone No. `72�-- �cS�= 9W Zi
Zip Code: % Fax:
E-Mail: W `4-19 3 �L 8 eA . /J Q+
Phone No. — g55t
Fill in fee simple Title Holder on next page (if different
E-Mail:
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: 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 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.
s
Signature of Owner/Lessee/Contractor gent for Owner Signature of Contractor/Licen older
STATE OF FLORIDA ASTATE OF FLORIDA
COUNTY OF 14,fie-77N COUNTY OF fjgeriN
The forgoing instrument was acknowledged fore me
this I day of 20 IL/by
(Na a of person acknowledgingl WM3WpfWU. b7WW
&fate d Flodde
Asp '1Vljlcoemtl ft E*MS oeM
.. - ------
(Signature of Notary Public- State of Florida ) /
Personally Known OR Produced Identification "
Type of Identification Produced iL 3�' L-
Commission No. l l a,'a3 b (Seal)
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this __L day of 0 ^ T 20 i r7by
CIN�taplbrD. Slleef
(Name of person acknowledging ftCG112=
1 0 A ,�
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification ✓
Type of Identification Produced (::7L _-PZ_
Commission No. I (aa3L (Seal)
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