HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
wilding 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
mom
Address: S CC
Legal Description:
Property Tax ID#;"2i:2�•SGS - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Slde: Left Side:
ala � �/ '.- 7 <(A)
'4'
Add
d under itional work to ok-me Orme ec a apply:
F1
k-_-JF1VAC Gas Tank ❑ Shutters Windows/Doors
F]Electric Plumbing E]Sprinklers M Generator Roof
Total Sq.Ft of Construction: X7,-1 0 SQ.Ft.of First Floor:
Cost of Construction:$
- , Utilities
ZS e .M Sewer I �Septic Building Height:
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Name Naine:-1'er/_-k_A CQ�A r->ICM4-�
Address:CU42A Z-2 Oct 0 an •q company-, I A Q t9
city--:��.A YZ:121'�LOC 1-N State.�4_ Aciclressi(,� V-v-
Zip Code:_ IAks-71 Fax: - city: state: 'L-
Phone No. -7 2 Zip Code:-7qs _z_
E-Mail: Phone No, 7 7 2- q U1•
Fill in fee simple Title Holder on next page(If different E-Mail: 'elff
from the Owner listed above) State or County License;
11 It value of construction Is$2500 or more,a RECORDED Notice of Commencement Is required,
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SOO/Loo 33IA83S*A8013V3*08VA088 1.681.1.99ZLLL Xvi z0:9L 9LOVOL/80
DESIGNER ENGINEER: _Not Applicable r 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.Lucle County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,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
iCnprovements to your property.A Notice of Commencement must be recorded and posted on the jobsite
fore the first inspection. If y u intend to obtain financing,consult with lender or an attorney before
c mmencin ordin ur Notice of Comm en ment.
Sl ture o w essee Si ure f o ense Hol r
ST OF LORft
STATE OF LORiDIJ
COUNTY _� COUNTY F WCC
The forgoing ins rument as acknowledged before me The forgoing instrument was acknowledged before me
this b day of Z0�by this day of"N Q
L .��0_11gbY
� r
(Name of p son acknowledgi g) (Name of petson acknowledge g)
.Ic._
rP&sonally
ture of o Pubif'C-gate of�i1��4 t E RUSSELLignature of N ry Public-Stateo Iorida) .Known ` Notary Public-state of Florlda= Pt 1tl6 IFS��tlly. Personally Known 13f'doducedIds �tAlf Identificat' ri Type of Identification Pr 0 4, -.1`:
IN _ission No. (Seal) Commission No. MyCohf�if�l�loo#SFFU03839217
,•,IIIIIu\
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
COMPLETE
INITIALS
i
800/Z0018 30IA83S*Aa010V3*08VA088 LE9LL9bZLLl XV3 E0:9L 9I0Z/0L/90