HomeMy WebLinkAboutRevised Permit ALL APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date; } i Permit Number: 1.� 0-0�J `
Building Permit Application
Planning and Development SeNices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)4621553 Fax:(772)4621578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address-
Legal Description
Property Tax ID#: LA t go(' (0 - — Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Lefk'Side:
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Adclitional worK t5 ff
orme un er is perm c eta appy:
1WHVAC Gas,Tank Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers Generator hoof
Total Sq.Ft of Construction_ S - Ft_of First(Floor:
Cost of Construction:$ Utilities. Sewer OSeptic Building Height:
,.Vr :•bf
Name Name:
Address: Company:
City; ' 'S- State:M Address:
Zip Code: Fax: City: t4,(tr("1S State_
Phone No. _ Zip Code: za vs Fax:
E-Mail; Phone No. a cat
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$2SOO 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.Lucia County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or ancl covenants that may restrict or prohibit such
structure.Please consult with yo6r 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.Lucia 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 our Notice of Commencement. —
AIAA I-A_91rD or
Signattire of Cor
r1t0av1C*+ XL"S older
Signature of owner/Lassee/Agent
STATE OF FLORIDA STATE OF FLORIDA \r\
COUNTY OF COUNTY OF ;
The forgoing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this n,i day of 20 L-r by this 01 day of—_ 3"14 20 I f by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida (Si nature OWUrafy—Fublic-State of Florida
P��nay OR Produced identification nail K OR ProdUced Identification
a.
Ion
'rcid'�
Type o [on Produced. Type of Identification Produced
Commission No. _X_ Ises,11111111) Commission No. 66 SI-30
SANTIAGO HERRERA
toy cor^GssION i E6833052
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Revised 07/15/240141%bw
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
_DATE
COMPLETE
INITIALS