HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Dote; Qos I za Permit Number:
4
Building Permit Application
Planning and Development Services
Building and Code Regufation DIVlsion
2304 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR' To Select from dropbox, dick arrow at the end of line
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Address: S- Ouan Dyiw. �!Iii l� �i a'� t .#n I � il1_ol
Legal Description: A i LL'
Property Tax IDW: Lot No.
Site Plan Name: 191oCk No.
Project Name:
Setbacks Front Back: , ,Right side:_ Left Side:
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Total Sq.Ft of Constructs n: Sq.Ft.of First Floor:
Cost-of Construction:$ Utilities: Sewer OSeptic Building Height:
Name cllilt
Address: Jq Zt J)fttV6l a P �'� f Cf Company-
City:
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Fill in fee simple Title Holder can next page(if different E-Mall: cl f i -Com
from the Owner listed above) ' State or County License:
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if value of construction is$2504 or more,a RECORDED Notice of Commencement is required,
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DESIGiNE ENGINEER: _Not A0007
ORTGAGE COMPANY: _Not Applicable
Name: ame:
Address: ddress•
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicably
Name: Name: "
Address: Address•
City: - City:—
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Zip: Phone: Z'1 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 Assoclpation 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:roorn additions,
aaessory structures,swimming pools,fences,wills,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, y4u.i intend to obtain financing,consult with lender or an attorney before .
commending war ire d ; our Notice of Commencement.
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Signature of ns e/Agent signature of Con e i se Holder.
STATE OF FLORIDA STATE OF FLO A
COUNTY OF
COUNTY OFfila m t t ,tt .i �� !
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The forgoing in strumpnt was acknowledged before me The forgoing instrument was acknowledged before me
this-day of V 20 IS by this'Zl day of l 20 V-) by
(Name of person owledging) (Name of person wledging)
I
(Signature ry
Public- of Florida (Signatur fPublic.State of Florida)011
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Personally Known OR Produced ldentificatioribAg r5b Personally Known OR Produced Identification&V V !
Type of Identification Froduc --. TYPe of Identification Produced - - W I
^,i„�•Y `� Liz r
! !.1/1$ 1VIA1Ei`Tl a�: CC)MNiisstON OFF,
Commission No. i �(5 a mission No-lr l~@'` 4 ,y,, , `�
Y OMMISSION*FF1 lsFe •.!` .r ENPIRI=S AuguSC 14, YS
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`a'barri i ExPlRf=$August 14, 16 FrasidaNal 6mv+ca.c
i's07)3'88-0}53 Flartdallopa,ys�NMCe,Com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEtly REVIEW REVIEW REVIEW
DATE
COM PLET1=
INITIALS I
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