HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date:
a�3d1 \S Permit Number:
_ �
RECEIVED APR 3 0 2015
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 Cornmercial Residential �—
PERMIT APPLICATION FOR; To Select from dropbox, click arrow at the end of line
Address:
Le�6'l � I tion:► -e-
Property Tax ID#: ` Lot Na.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
rep1
itio wor o [Irformed under is permit–c ec a appy:
HVAC Caas Tank ❑Gas Piping Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft,of First Floor:
MT
Cost of Construction:$ Utilities: Sewer[ Septic Building Height:
Name 1 Nam
•rn
Addr Company: Jbg `
City: + State: Address:
Zip Code: Fax: City: Stater
Phone No.�-7�-4(�A f S I S Zip Code: FaX: ��� ��D�•�{ n '
E-Mail: Phone Ngo. "1Z
Fill in fee simple Title Holder on next page{if different E-Mail:
from the Owner listed above) State or&ntv License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone- Zip, Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
ZIP: Phone: Zip: Phor.e:
I certify that no work or installation has commenced prior to the Issuance of a permit.
eCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
"hil s In
which I conflict with any applicable Home Owners Association rules,bylaws or covenants that may restrict or prohibit such
structure.Please consult with your Horne 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
impCovements to your property.A Notice of Commencerqent must be recorded and posted on the jobsite
befcte the first inspection. If you tritend to obtain fin ar ncirr, consult wit lender or an a torney before
comMencing Wdin g vc%r Notice of Commencernent.
5ignat I lr�e of sse Sig a coytra Icse HJold
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STAT OFF STA E OF
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The forging Ins�'r�
e fare me The forgoing Instrovent was acknowledged before me
thl �day of by this_"qday of
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(Name of pers n acknowledgin , (Name of pen acknowl
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lonature brNotary Public-State of Florida tire df_�otKPublic-State of Florida
0 Personally Known "DR Produced IdenC ion' z Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced o Cn
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Commission No. Commission NdU"GKXSX-
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
I L
800/8001A 30IAd3S*A8013VA*088&089 L69LLSVZLLL XVJ 00:6L 9L0Z/8U7/V0