HomeMy WebLinkAboutBuilding Permit Application Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Divislon
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
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Address:
Legal Description: toey,2� 1=& N.7h A-9 BLL
Property Tax ID#: l' 01 Coll Q 4 00 Lot No.
Site Plan Name: � - .. _ Block No. 11
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona wor o e e orme un er is perms -c ec a appy:
MVAC �Gas Tank Gas Piping _Shutters �windows/Doors
Electric Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: S .Ft.of First Floor;
Cost of Construction:$ t'"�.� Utilities:11 Sewer Septic Building Height:
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Name "D �� Name- S
Address.\
rl � ti �,..,,,,.. Company: i
city: VCZ\- MKP _.__. State: .. Address: k S
Zip Code: 2?\44 S71 Fax: City: Sz2--�' �tDuo Stated(„
Phone No. � 1 l a$_�.__ Zip Code: 3ARS&A p. Fax:
E-Mail: Phone No. no) \AN—
Fill in fee simple Title Holder on next page(if different E-Mail:� +_ft n f1f1C1 s AC Q0
4
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice c Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City; State:
Zip: Phone: zip: Phone:
FEE SIMPLE TITLE HOLDER: t Applicable BONGING COMPANY: of Applicable
Name: Name:
Address: Address:
City: - City:
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
which is in conflict with an 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 pians,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
cornmenciniz work or recording-your Notice of Commencement.
s
Signature of Owner/Lessee/Agent Si ature of Contractor/License Holder
STATE OF FLORI STATE OF FLORID
COUNTY OF__`� llCJ� � �LO
COUNTY : G'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of..1 / . 206--by this:: -- day of.._l G .20 1-'5 by
J,�)07,6 4,0file-5 Jal,:ne,5 e-5
(Name of person acknowledging) (Name of person acknowledging)
7ersona
ure of Notary Public-State of Florida) (Signa ure of Notary Public-State of Floridally Known OR Produced Identification Personally Known O R Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. a`'+"�"wall. SANDRA MOMMA omm cion No. +'pry ,, ea ANDRA HOHMANN
S g Lary public-Stale Ronda �+�. ;'*'S Notary'Pubtic-State of Flori
g •• My Comm.E tr
ay a" ommission,a FF 071880 "�, "aT�- Commission N FF 071680
Revised 07/15/2014au"tNatlord %iRa n"P+
Notary M Bonded Dr100 d Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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