HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.
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ALL APPLICABLE INFO MUST BE COMI- ED FOR.APRLICC& ION TO BE ACCEPTED
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Date: `� 1 �`� �5 Permlt`0-6mber: (5 6 5 - O a-7 5
RECEIVED MAY 19IN
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BuildingPermit Application_ As
Planning and Development Services t73NNVOS
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•Iine A-Y" '
Address::_
Legal Description:
PropertyTaxlD#: 3;-lI,oa -r,06 ? d = O'6 a- —3'.. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:' " Right Side: " Left SideJ '
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57`gr7 �t* J�.F Go!'n .e i' An9IE TO N(AI', COr'✓��/'
AaanionaiworKtooe errormea unaertmspermit- cneCKau apply: -
0HVAC Gas Tank ❑Gas Piping _Shutters QWindows/Doors
Electric O Plumbing ]Sprinklers Generator 11
Roof
Total Sq. Ft of Construction: S " R of First Floor:
Cost of Construction: $ :� SO .' , Utilitiesf.. D` • Sewer FjSeptic Building Heightr
17U•�1'f`R�'LES �E='" �"�- �` : �`�' � `�
"@ON�T#RACfO e
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Names'
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Name:'.' '•• •,
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Address: •< '6 O ' %[/`^ e�C �� -
Company _ C.O
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Address:
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City: �C?�� �..
LI Cam! t? State:
Zip Code: Fax: ---
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Phone No. 7� " 4; 0 7 G
Zip Code:
Fax:
EMall:
Phone No. —
E-Mail, 5•'4gA2
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Fill in feeslmple Titleholder on next page (if different
State o County License:
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from the Owner listed above)
IIIf value of construction Is $2500 or more, a RECORDED Notice of Commencement Is required. II
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: -Name:-
Address: -Address:
City: State: City: State -
Zip: Phone: Zip: ` Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
is 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",
I 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;•
accessorystructures, 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
Sigrfature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLOR't
,
COUNTY OF 5-k, L vc t
COUNTY OF `� k. 1-yc
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this\ *� day of ` v%*+ 20 t- by
this iL day of Y v,*R 20� by.
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S c.r, 1�l- Pi��:rs-� ..-.,
"�c.a Nr 'Qe•fie c� -,
(Name of person acknowledging);
(Nameof person acknowledging)
(Signature of Notary Public -"State of Rod ' 1Np�'\ a o%F� Zo�b
{Signature of Notary P lic- State of Florida
ptiP' 9`a� °`-'6. ;
Personally Known oduce�Iyl@1�e50tg.•ss°
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Personally Known OR r gflt 1
1 f�OR�'
Type of Identification ".' : N° t °° �N�"'
Type of Identification' 6u oI
e
`- wl e°m I ht
Commission No. L- • ;,,.
. ,.: ^.° •,9 1;' oral m. E Pees 06C ge7et
Commission No. om 1(9 " �.
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Revised 07/15/2014 J
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