HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J Permit Number:
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grrpitApplication
Planning and Development Services
Building and Code Regulation Division JUS! 0 5
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1571 Pe (jmrnercial Residential (/
t. Lucie
PERMIT APPLICATION FOR: .To Select from dropbox, click arrow at the end of line
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Legal Description:
Property Tax ID#: Yoz ^ Ocosy— Cj00 �5' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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orme un ert is permit-checka appy:
HVAC []Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer Septic Building Height:
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3WIV ER/LESSEE F CONTRA OR �� x t
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Name ke, e,. 1 Name: �Q,Y N e_1 4- ��j'�-� -
Add'cess: ` �:/,. .0 - (ti7a0o� Lo Company Za C. ,` ��n kVt/� o
City ' Stat_ Address
Zi Code:' ' �/' Fax: /V Cit
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Phone No. s 7 �1 3 Zip Code: .J�{q 3 Fax: ! '�
E-Mail: 1V Phone No. q7Z/ 5.3U 2%�j-
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: G d Z G I:
Stlt�PLEIVl�1�lT�4L CONS1TR�U%?,l JN II �U"!�W INFQRMA1'IC?(V y��
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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Signa-u-r f Owner/Lessee/Agent Signature C tractor/License Holder
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STATE F' ORIS STATE O F RID
COUNTY OF ,�c,�,`' COUNTY F �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of��{'_ 20 J by this S day of '�� 20 1L by
�UF�� �CSZC�C ir,l z� 1"I cu,r r
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Flor a) (Signature of Notary Pu)li - tate of Florida
Personally Known OR Produced Identification Personally Known OR Prg4uced Identification-'tmGla-bh
Type of Identification Produced I(A1Glc. YW T- 1)ceaUe_ Type of Identification Produced '1'IUVt[,(C. T)wyer-I I t&-%e _
., MELISSA JUDITH ESP SAR i(MELISSA J
Commission No. �^��CI 4,®• �RYPUBLIC commission No �e� YVOTgRypUBITHE DA
i STATE OF FLORIDA STATE OF uC
Expires 2/25/2018 •INCE a Expires Revised 07/15/2014 212512018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS