HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE
Date:
'ED FOR AP�PLICATIO,N�T�O BE ACCEPTED 1 rX� 5 " O��
If Uo
Permit Number:
" I RECENED
Building Permit Applicatioh MAY 2A 2010
Planning and Development Services
Buildingand Code Regulation Division Permitting Deppartment
9 Ot LiI �BIlfl1y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-I 578 Commercial Residential
PERMIT APPLICATION FOR: To elect from dropbox, click arrow at the end of line j
Property Tax ID #: 7' Oce " b Lot No.�
I
Site Plan Name: Block No.
Project Name: 3` I
Setbacks Front~ Back: I Right Sid : Left Sid S L
lux J-t4t�
Atltlitional worK to De errormed uncler tnis permit— cnecK all apply:
�HVAC Gas Tank Gas Piping Shutters Q Windows/Doors
Electric c 0 Plumbing Sprinklers M Generator Roof
Total Sq. Ft of Construction7:1` a / I S . Ft. of First Floor: f I �/ 4
Cost of Construction: $ J6nl , �U Cv I Utilities.
Sewer Septic Building Height:
I
owNER L1�SS
CONTRAS � r R
Name e/ "�
Name:
Address- l�Pi1� P.{`�d �' i
City:( State: _
Company: ✓rvl�
Address: / ,(a� /�• '
Zip Code:,3-�ZYQ Fax: I
City: State:
Phone No.
E-Mail: .i�h) (� f ffY° f�//�,�i�71J7>?S� r%a1�
22
Zip Code:Fax: L,
Phone No.
E-Mail: OL° 0 al 2— i
Fill in fee simple Title Holder on next page (if different
from the Owner listed above) I
i
State or County License:
It value of construction is 5Z500 or more, a RECORDED Notice of Commencement is required. I
DESIGNS
Name: _
Address:
City:
Zip:
FEE SIMPLE
Name:
Address: _
City:
Zip:
HOLDER
one:
I certify that no work or installation has coma
St. Lucie County makes no representation that
which is in conflict with any applicable Home (
structure. Please consult with your Home Owr
In consideration of the granting of this requesi
in accordance with the approved plans, the FI(
The following building permit applications are
accessory structures, swimming pools, fences,
WARNING TO OWNER: Your failure to I
improvements to your property. A Not
before the first inspection. If you inten
commencing work or recording vour N
`Signature of Owner/ Lessee/Agent
STATE OF FLORIDA aQ
COUNTY OF
The f r oing insbKment was acknowledge
ti # day f 20
(Na{ne of person acknowledging)
(Signature of Nota �Pu
Personally Known
Type of IdentificatigQ�rQ
Commission No.
Revised 07/ 15/2014
Applicable
n
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY
Name:
Address:
City:
Zip: Phone:
enced prior to the issuance of a permit.
_Not Applicable
is granting a permit will authorize the permit holder to build the subject structure
wners Association rules, bylaws or and covenants that may restrict or prohibit such
ers Association and review your deed for any restrictions which may apply.
ed permit, I do hereby agree that I will, in all respects, perform the work
rida Building Codes and St. Lucie County Amendments.
exempt from undergoing a full concurrency review: room additions,
walls, signs, screen rooms and accessory uses to another non-residential use
,ecord a Notice of Commencement may result in your paying twice for
ce of Commencement must be recorded and posted on the jobsite
I to obtain financing, consult with lender or an attorney before
)tice of Commencement.
s
Sig ature of Contractor/License Holder
STATE OF FLORID
COUNTY OF
me The for oing instru was acknowledged efore me
this day of 20 by
l
(Name of
- S e of Florida) (Signature of Notary Public- Sue of Florida )
OR Produced Identification Personally Known OR Produced Identification
c Type of Identification Pror4e'
ara�r+Notary PubliSta of Florida " Notary Public State of FloridaCommission No. Fran Jionza
'a My Commission GG 092440 �� My Commission GG 092440
�'OFftio Expires 07/27/2021
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