HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONW
ALL APPL,ICABLE INFO_MU_ST BE COMPLETEDIFOR APPLICATION TO -BE ACCEPTED_
—II__
Date: I��1—
_
(�
Permit Number: l I0I—
RECEIVED
_
BAN 2 91019
Building Permit
Applicationp m,alngoe
Planning and Development Services
Building and Code Regulation Division
st, Lucie -Coast 9nt etas
Y n
p •_ �i
_
2300 Virginia Avenue, Fort Pierce FL 34982
_
�LO `Q
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:
Legal Description:
67
Property Tax ID #: 10+
S Lot No.
Site Plan Name: A
Block No.
Project Name,
Setbacks Front Back:
CRightSide:
10 Left Side:
s s �
-j'
wv 1
Aclortionai worK to ne nerformeydun ert ispermit—c ec
a apply:
❑HVAC Gas Tank ❑Gas Piping
_ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing []Sprinklers
❑ Generator Roof
Total Sq. Ft of Construction:
ScFt. of First Floor:
Cost of Construction: $ `S�a y , Utilities: Sewer ❑Septic Building Height:
Name nAth>`
Name:
Address:L00 •
Company:
City: D State: _
Address:
City: U State:
Zip odeii�9110,P Fax:
Phone No.
''//
Zip Code: T// Fax:
E-Mail:
Phone No. �y2/•
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500or more, a RECORDED Notice of Commencement is required.
W 4
I7PPLEMENTAi . S •RUCTION
CIE UV INFO'RMAT
BE
Name:
_Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
A
in
Address: A
City:_
Zip: Phone:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name: �t�a
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
_'Signature of Owner/ Lessee/Agent
STATE OF FLORIDA 4. �J STATE OF FLO
COUNTY OF /«j//yl7 a6l_ COUNTY OF Aacz_
The ing instr ent was acknowledge efore me
th r oday o 2V by
(Name of person/a/cknowledgin� )
(Signature of Notary public -State of,F,fo
(rida )
Personally Known _ OR Produced Identification
Type of Identifica
The fo oing ins u ent was acknowledged before me
this2 day of 20 l by
(Name of pefson acknowledging)
(Signature of Notalry Public- State of Floypda )
Personally Known 1�/ OR Produced Identification
Type of Identification Produced _ _ R 0 A ni.Rftil`
Commission No. •' " Frances Dot�tg,n Commission No.
mlylUnn''GG0 092440
7ww FmxpIm07n7202t
Revised 07/15/2014
FPy� w Fkida
- ..__...t.�. GG 092440
REVIEWS
FRONT
PERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
4REVIEWREVIEW
COMPLETE
INITIALS