HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date::3D SCANNED Permit Number: M — d Lill
BY
=,t. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
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: II
Legal Description:
Property Tax ID H: lJ Lot No.AN—
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
Total Sq. Ft of Construction: /-�
Cost of Construction: $ 00
Sq. Ft. of First Floor: _
Utilities:Li Sewer Septic
Address: 101 b.S., (__ 0i� Lip- 70;�
Cityy�� -State: ELI
Zip Code: _Zi� 4-lE-. Fax:
Phone No. Eta
E-Mail:
Fill in fee simple Title Haider on next page (if different
from the Owner listed above) .
Building Height:
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Address: `
City State:
Zip Code: S44:R4; 4' Fak: a�'�
Phone No. c 20Q
State of County License:
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER.-
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Not Applicable
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Applicable
Address:
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Address:
City:
• Phone:
—TITLE
State: 11
city:
• Phone:
State:
FEE SIMPLE HOLD E_R:
Not Applicable
BONDING COMPANY:
Applicable
Name:
Name;
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Address:
Address: —
City:
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/ 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 andcovenantsthat 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-residentlal 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 woEWrecording yo4r)Wtice of Commencement. _ ,✓1
Signature
Signature
STATE OF STATE OF FL
COUNTYOFORII�A 1 1COUNTYOFORIDA
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The oing inst ent was ack wledged before me
this E y of 20 14 by
(Name bf person acknowledging )�
(Signature of Notary Public-S to of lorida )
Personally Known IV/ OR Produced Identification
Type of Identification Produced
Commission No. J (Seal)
Holder
T omg instr nt w a n wledged before me
t I' ay of ,20_1_4 by
1
(Name of person ackn wledging )
(Signature of Notary Public- a e of Florida P)
Personally Known V OR Produced Identification
Type of Identification Produced
Commission Nor'-�I"[ tl/ eal)
Revised 07/ 15/2014 MY COMMISSION # EE187483
EXP FA JM 25, 2016
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REVIEWS FRONT ZONING SUPERVISOR PLANS
COUNTER REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
Lm CRYSTAL MARIE
MY'COMM["10
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VEGETATION
REVIEW REVIEW
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