HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC/ABL fINF MUS COMPLETED FOR APPLICATION TO BE ACCEPTED 11
Date: L9 1®� Permit Number: 1y �'� �Cq
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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
P�ROFOSfD IiVfPRfJU IUIENTL®:CI�TION a
Address:
Legal Description:�]��� �� Q_,
Property Tax ID#: l ' C�`J` l ,�n �E` l� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Connect Pepe 4i�-arn� w me-tr -fD
Additional work toe e orme under this permit-check ka appy:
HVAC Ei Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First"Floor:
Cost of Construction:$ 1�� Utilities:n Sewer Septic Building Height:
.F.
{ y x, ev ..:y.. x,
®1J1lNER£/LESSEE Y
Name Name:
AddressI94_�-,�) ct rC43fz itl\L4 Company,
City:1 Stater Address:
Zip Code: Fax: City: State:
Phone No`,�r`�-`�� -� r Zip Code: Fax:
E-Mail Lc�m Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State o ounty License:
If value of construction is$2500 or more,a RECORDED Notice of CqKmencement is required.
�S[J'PPLEfUIENTALCONSTRI.ICT:I.O.NaLI'EN LAIN IN;FORMAl-ION': W � � �
DESIGNER/ENGINEER: _Not Applicable R MORTGAGE COMPANY: Not Applicable�y
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
commencin ,Mork or recording our Nptrce of Commencement.
-�� s
_S gnat of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA n STATE OF FLORIDA
COUNTY OFCOUNTY OF
The forgoing instru nt was acknowledged�re me The forgoing instrument was acknowledged before me
this J k Jay of (o 20 y this day of 20 by
C \
(Name of person acknowledging) (Name of person acknowledging)
(Si ature of NotZ Public-State of Florida) (Signature of Notary Public-State of Florida) .
Personally K oy1�•���y°�e% OR P c ificatio Personally Known OR Produced Identification
_. otary bl - f lorida
Type of Idel ®t' roduco Type of Identification Produced
'9.F oa' My Comm.Expires adz' 2019 Commission No. (Seal)
Commissio Ndr.,,oF«,.• o , ,,,-_ +��
� oughNatio a o yAssn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW , REVIEW
DATE
COMP LETE
INITIALS