HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONj
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: 150(D oog3
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial X Residential
SCANNED
BY
St. Lucie County
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: _`�
Legal Description:
PrcpertyTaxlD#: ZJII. Zl
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
;PETAIL'ED DESCRIPTION OFWORK:,',
S al gvl6u"C � socm i 3�-dcc4-r czX rbz)t&.
`CONSTRUCTION`INFORMATION: °
.
rtiona wor to
a erorme un ert erm ispit—check-
a apply:
OHVAC
F] Gas Tank Gas Piping
❑ Windows/Doors
Electric
0 Plumbing ❑Sprinklers
_Shutters
Generator1:1
Roof
Total Sq. Ft of Construction:
ScFt. of First Floor:
Cost of Construction:
$ f d c7 Q Utilities:Sewer E]Septic
Building Height:
QWN,ER/LESSE-E:
CONTRACTOR:
Name
Name:
Address Y
Company:
City: State: _
Zip Code:�49 Z Fax:
Phone No.
AddreW
City: State:
ZipCode.3Ligz2_ Fax:
Phone N.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail q 001
. Ciom
State or County License:
IT vame oT construction is >Zbuu or more, a x[COKDhD Notice of commencement is required.
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 thedpermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 vour Notice of Commencement.
STATE OF FLORIDA STAT FLORIDA ' ' L ,
COUNTY( � COUNTY OF ' W C4
t
The ffo�or��gQQIng instrpme t was acknowledged before me The for ing instr �ept�w,�as�acck�n�o�wledged before me
this%Ylr.�day of r P *dging
VIY�tM�Z Lf thisdayof_�v 1Lt/20by
(Name of person acknowl(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known y OR Produced Identification
Type of Identification Produced
Commission
Revised 07/15/2014
BAENDA MARTINEZ
Notary Public - State of F
Commission # EE 98807
(Signature of Notary Public -State of Florida )
Personally Known —L OR Produced Identification
Type of Identification Produced
BRENDA
Commission # EE
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
2015