HomeMy WebLinkAboutBuilding Permit Application JUN-08-2015 VQl l 12:41 PKI CENTRAL SCHEDULING FAX No 32126861,38 X r0i3 'P' 002
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- _ - - Building Permit Application
Planning and development•Services
Building and Code Regulation Dtvlsion
2300 Virginia Avenue,Fort Pierce FL 34.982
Phone:(772)4621553 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: 1
Legal Description: ,� � � ��1 f,l f Q lYY 17"rW
Property Tax ID#: — Lot No..
Site Plan Name: Block No.
Project Name:
Setbacks Front, Back: „Right Side: Left Side:
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Additional work-o e e orme un er t !s perms —check a apply:
HVAC Gas Tank []Gas Piping _Shutters [1 Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Comtructlon: Sq. Ft.of First Floor:
Cost of Construction:$ � Utilities: Sewer Septic Building Height:
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Address: Company:
City: ��` Stater Address:
Zip Code: y Fax: City: \ e' State:[
Phone NoM ” J^ Zip Cade:
E-mail: Phone No. _ �!)_ 1300L
Fill in fee simple Title Holder on next page(if different E-Mail jI
frorn the Owner,listed above) State or County license: � �$
if value 0f construction Is$2500 or more,a RECQRDED Notice of Commencement is required.
JUN-0$-2010 MON 12 441 PM CENTRAL SCHEDULING FAX No. 26 38
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DESIGNER/ENGINEER., Yls c '
—Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: _ Phone: Zip-, Phone: —
FEE SiMPL,E TITLEHOLDER: _Nat 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 Count, makes no representation that Is granting a permit will authorize the permit holderto 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 follovr`ing building permit applications are exempt from undergoing a full concurrency review;room additlons,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessary uses to another non-reslderntial 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 retarded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commenqU work or recording our Notice of Commencement.
Slgnat re 3f owner/Agent/Lessee Signature of Contractor/LlcenSe older
STATE OF FLORIDA :� STATE OF FLORIDA
Op �
COUNTY -- __ COUNTYOF �iCft l
The f going instrument was acknowledged,,b fore me The f rgoing instrument was acknowledged before me
this d �
ay of � J 20 6}r tills day of 2o__6 by
(Name of Orson ac owledging) iaamg f person ho edging)
{Signature of Notary PPubli75-tate of (Signature of Notary Public-State of F rida)
Personally Known `'' OR Produced Identification Personally Known ,OR Produced Identification
Type of Identification
Produced Type of identification Produced
commission NOT11�✓"�G '�`� �Y`�'tt therine X`onpr Commission No. "l�9 _ ���•`�p ,e8
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Expires:OCT 2&,201 '�: �;3C0awsom4FF17237
T$TFLOSUPANOTARY,UG �"'•i�,�.+,"��y.3srFio EDTH U l+B�'
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
6ATE -
COMPLETE
INITIALS