HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
I
SCANNED RF�FI�Fo
BY MOP
Building Permit Application St LucieC06TOYttn '401e
Planning and Development Services St <p e0co epart
t�e 4F
Building and Code Regulation Division y
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: ! r060 U (�
Legal Description:
Property Tax ID#:
Site Plan Name:
viiririATW1&1s.9t
Lot No.-O
Block No.
iarcionaiworKtooe errormea unaertnispe it — cnecKaii appiy:
11HVAC 0 Gas Tank ❑Gas iping _Shutters Q Windows/Doors
Electric El Plumbing Sprinklers ElGenerator E]Roof
Total Sq. Ft of Construction: S Ft. of First Floor: _
Cost of Construction: $ Ll 00 Utilities: Sewer � Septic
Building Height:
NameWLI,Y— Name:
Addre • Company:
City. State: _ Address: L,9(porl
Zip Code: Fax: City: State:
Phone No. Zip Code: / Fax:
E-Mail: Phone No. �
Fill in fee simple Title Holder on next page (if different E-Mail-A i;t/
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not App
Name:
Address:
City: State:
Zip: I Phone:
FEE SIMPLE TITLE HOLDE J Not Applicable
Name: /
Address:
City:
Zip: Phone:
MORTGAGE COM
Name:
Address:
Not Applicable
City: State:
Zip: Phone:
BONDING COMPANY: /� Not Applicable
Name:
Address:
City:
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. Pleasel 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
commencinia work or recordiniz vour Notice of Commencement.
_prgnature of Owner/ Lessee/Agent
STATE OF FLORID
COUNTY OF /f%%
i
s
SlAnature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for oing instr ment was acl owledged efore me The forgoing in trument was acf n_owledge/d efore me
this day of 20 ,by this " day of lf'� 20 / f by
(Name of person iacknowledging) (Name o person acknowledgin )
/.'� 'C � /n, - 77tu L&e'
(Signature of Notary Public- S ate lorida) (Signature of Notary blic- Stat f Florida )
Personally Known Personally Known OR Produced Identification
Type of Identification ogRge Type of Identificati
Commission No.
Revised 07/15/2014
LExl3ires
Donza Gov °ya Notary Public State of Florida
R9�I�n GG 092440 Commission No. _° '` Frances DolMal)
7/2772021 y < My Commission GG 092440
14_-..off' E),ires 07/2712021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
(COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
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