HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .,
Date /Sa0Ps— Permit Number /Sb(0 -claq
Building'Permit Application
Planning and Development Services
Building and Code Regulation Division.
2300 Virginia Avenue,fort Pierce rL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential L
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 77
Le al Diptton:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: I
Setbacks Front Back: Right Side: Left Side:
9-AfY\
_U3
Addition worko e orme un er is perm —cRecarapp y:
MM.MMNM"
VAC 13Gas Tank ❑Gas Piping _Shutters windows Da
/ ors
13 Electric El Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: 5 . Ft.of First Floor:
Cost of Construction:$ Utllities: Sewer[:J$eptic Building Height:
Name
Name. VVII
Addr n
company-
City: - 'No. State.EL Address:
v
Zip Code: �-{ Fix: �
Phone . 4 �. City' State 'L
ZIP Code:E-Mail: Fax:- -3I
Phone No
FIII in fee simple Title Holder on next page(If different E-Mail: ' A '
from the Owner listed above) f^
State or County License:
If value of constructlan Is$2500 or more,a RECORDED Notice of Commencement is required,
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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 anapplicable 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 addltlons,
accessory structures,swimming pools,fences,walls,signs,screen roams 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
'm
ovements to your property,A Notice of Commence rqent must be recorded and posted on the jobsite
be" e the first inipection. If you ILntend to obtain financitp,consult wit lender or an attorney before
cornicencing w2dpeffeewdinR Ydur-Notice of Commencernent. I
Signa igrVFtuT;reo Mra0w4ice Xi-e Hold
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.R he forgoing Instrulnent was Icknowledged befo tri The forgoing instrument was acknowledged befor riv.-9 C3
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-(Name of P*son acknowledgj) (Name of&soni-acknowledgi g)
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�(Signature aff otary Public-State of Florida) Ignature of0tary Public-State of Florida
Personally Known ✓ OR Produced Identification Personally Known--��®R Produced identification
Type of Identification Produced Type of Identification Produced
I
Commission No. rr- --ZS (Seat) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR. PLA i N.5 VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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