HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �_/�
Date: Permit Number: I.3 �1' D/��
Building Permit Application SCANNEL/
Planning and Development Services St, LU CIBB COl l r
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 III
Address:
Legal De:
Property Tax Ili#:
Site Plan Name:
Project Name: _ n A/a /Q/n A02az///J/'
Setbacks Front Back: Right Side: Left Side:
t:r 40_ U 1-?Oaa,
u
LJHVAC "Gas Tank UGas
Electric Ej Plumbing 11Spi
Total Sq. Ft of Construction:
Cost of Construction: $
na—cnecrc an apply:
Piping _Shutters
nklers ElGenerator
_ SpI �Ft. of First Floor: _
Utilities:In Sewer D Septic
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
C3WNER/LE
E &M "'
r
GONT G7OR2" r r lK 11 .»
Name
Name I
f '
Address•
Company:
City:
Zip Code: �2�qw_cpFax:
% Phone No. 7�—�%9=
State:
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City: E'Y�• rPi
Zip Code: �79dnoZ Fax:
Phone No. Z1
Stat
E-Mail: �t%�%^%
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
U=urvtK/CIVUIIVttK: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certifythat no work or installation has commenced prior to the issuance of a permit.
_Not Applicable
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.
Signature of Owner/ Agent/ Lessee Signature of Contractor/License Holder
STATE OF FLORI A STATE OF FLORIDACOUNTY OF M.J_A J6P_, COUNTY OFP.
The for ing instr fnent as ack owledged.before me The forgoing instrument was ack owledged before me
this�dayOf�20 14by this,` dayof 1g by
W //% 0�/A_c Jj d&,CZ n.
(Name of person acknowledging) (Name of person acknowl dging )
(signatur%bf Notary Public -State of Florida )
Personally Known —ZOR Produced Identification
Type of Identification Pr�oQduuccjeeddq�/
Commission No.Q�/* (Seal) .
•"I",,,, MOUELOROYFN.
Revised 07/15/2014 ?F`�•' s� Notary Public • State at I'll
•' My Comm. Eaolm Mar 18.
(Signature NotaryPublic-State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced Commission No.
�/ ��(� (Seal)
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