HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� ,, Permit Number:
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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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description:
Property Tax ID#: 456)l•- 60 4_6 y® - (0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e Orme un ert is permit-c ec a appy:
HVAC Ei Gas Tank ❑Gas Piping 1:1_Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers 1:1 Generator El Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
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Cost of Construction:$ ) 99`I' � utilities.. _Sewer Septic Building Height:
O1II 015 LESS
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Name A-, i _.g re�G Name: ivi'1 it o'1J0 _.
Address:' �''l 0 ��r'u:.�cyia '���� Company:r7 L
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City:', . �4 State: Address::J ?'q( 5 < .e sclws�•
Zip Code: Fax: City: Stater
Phone No. 310^ 310 Zip Code: 5LM S3 Fax:
E-Mail: Phone Nom� C 1-11') 5,
Fill in fee simple Title Holder on next page(if different E-Mail: OCIII W(SOLL4.;,
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPP`l EMEN7 AL Ct�NSTR 071:4 �l f N Lfi1IV IN 50RRMMI F'Nf z ,
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a..!u.. :�� ar. .,. ::,z5i3�=' asi� u:Zm�:rc� s $ �J.M.< '. x',
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: 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 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,
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
commencing work or recording our Notice of Commencement.
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_Signatf Owner/Lessee/Agent Signature of ractor/License Ho
STATE LORIDA STATE F ORIDA
COUNTY OF S¢/�/L'� COUNTY OF
The forgoing instrume t was acknowledged before me The for oing instrume as acknowledged before me
thiday of 20` by t�day of 20/
by
(Name of person ackn edging (Name of person acknow )
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known X OR Produced Identification Personally Known Y OR Produced Identification
Type of Identification Prod edna Ann Weinman Type of Identification Produced CatheineXin Weinm
NOTARY PUBLICc � PUBLIC
OF FLORIDA TATE OF FLORIDA
Commission No Commission No
• Comm#FF145934 omm#FF145934
Expl,9s 6/2312018 Expires 8/23/2018
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS