HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)SCANNED
By
ALL APPLICABLE INFO MUST BE COMPLETED FO I PP�fCF 2N TO BE ACCEPTED
Date: / ��• �, Permit Numb
RECEN
Build! g Permit Application JAN 1 'l 2019,
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial esiRn4Mci County, FL
PERMIT APPLICATION FOR: To Select �rom dropbox, click arrow at the end of line
Address: % 0171
Legal Description: l5
Property Tax ID #: L
Site Plan Name:
Project Name:
Setbacks Front Back:
Haaitionai worKto oe errormea u
1JHVAC _ Gas Tank
D Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Lot No.-4
Block No.
C-/-
Side: Left Side:
nit - cnecK au M appiy:
Piping —Shutters , Q Windows/Doors
nklers F1 Generator Roof
_ Sq.
of First Floor:
Utilities: L_JSewer ElSeptic.
Building Height:,_
Name Q1-- L
Name:-
Address:
Company:
City: / State
Address: D Al Q
City: .og State:
Zip Code: old Fax:
Phone No.
Zip Code: Fax:
E-Mail:
Phone No. eo/- ""l L
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:�Aw®
State or County License: C • 65 nd 67 .
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address
City:
Zip:
Phone:
of Applicable MORTGAGE COM Y: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMP Not Applicable
Name: �� Name: AIJA
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
I certify that no work or installation has commenced pllrior 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 Assgciation and review your deed for any restrictions which may apply.
r)I In consideration of the granting of this requested perit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Bu Iding Codes and St. Lucie County Amendments.
The following building permit applications are exemptifrom 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
commencine work or recordine vour Notice df Commencement.
_ ignature of Owner/ Lessee/Agent
STATE OF FLO
COUNTY OF
The forgoing ins
t ent was acknowledgecjbefore
this � day o 20 l by
(Name of person acknowledging)
(Signature of Notary Public{'§tate of Florida
Personally Known OR Produced
Type of Identification Produced
Commission No.
Revised 07/15/2014
Notai§molic state of Florida
Frances Donza
my Cnmmiasion GG 092440
STATE OF FLO DA
COUNTY OF `� Ci
The forgoing instr ment was ackn owl edgeo, before me
this 4 day of 20 by
4 u
, �yLi �tL
(Name of person acknowledging)
(Signature of Notary, Pub ic- S to of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. Pu NotarYpu
gi of Florida
Frances
„ My commissionG 0924420
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