HomeMy WebLinkAboutBuilding Permit Application Date: Permit Number:
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 dropb ox, click arrow at the end of line
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Legal Description:Q341 qQ SC i/Y ArYJ, .(_7 1/1ZA 11q 9 SW ilw &IIJ e
Property Tax ID#: QZ�Z)( —CC�)O 2_ Lot No.
Site Plan Name: Block No.
Project Name:
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Setbacks Front Back: Right Side., Left Sidew.
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Additi alworktolo rtormed unaEr tliii oiffn_F!Cre&all apply:
VAC Gas Tank 1:15as Piping Shutters Windows/Doors
RElectric Plumbing OSprinklers ❑Generator ❑Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor;
Cost of Construction. to zgn Utilities: Sewer Septic Building Height:
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Name zae& Name:
Address:42, I>a4wi, AL)0_ Company: -SIM73A
City: El:aeaa State: LZ-. Address: U
Zip Code! L!?/qV Fax: 11?
City: isgb2z"" /� state:
Phone No. /sYs Zip Code: . 14 3� &' Fax: V4
E-Mail: Phone No. 14(-P/— EZZZ
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License":
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNERANGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State., City: State:
Zip: Phone: Zip. Phone:
FEE SIMPLE TITLE HOLDER: Nbt Applicable BONDING COMPANY:, )4�_ ot Applicable
Name- Name:
Address: Address:
City: City:
L 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_your Notice of Commencement.
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nature of Owner/Lessee/Agent Sig lure of Contraftor/Llcense Holder
STATE OF FLORIDA STATE OF FLORIDA
IUZ e e
COUNTY OF laele COUNTY OF - r . _
`The forgoing instrurrignt was acknowledged before me The forgoing instrumgnt was acknowledged before me
this, day of 20 1:::C6y this
_j day of20 LI by
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(Name of person acknowledging) (Name of person acknowledging
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(Signature of Notary Public-State of Florida) (Slgnatu of Notary Public,State of Florida
Personally Known OR Produced Identification Known L--' OR Produced Identification
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Type of Identification Produce djh,,���n,4MAI hype Identification Produced
Florida
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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