HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I O MU BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
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 dropbox, click arrow at the end of line
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Property Tax ID la 1� - 030 " CDC-) - 3 ____ _ __ _ ____ _____ Lot No.- 1 (0 _
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Project Name: L01"f--M cfC
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Additional work to be pertormed under this permit—check all i appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers 1:1 Generator LSI Roof
Total Sq. Ft of Construction: S S . Ft. of First Floor: 7i?65-P Sr—
Cost of Construction:$ �, y�� ,�(_ Utilities. —Sewer[]Septic Building Height:
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Name P caU-1 Name:
Address:kP'50� gOLntO, C�CU-A lV Company:
City: State: Address: t.�S
Zip Code: f)LJ Q 5A Fax: City: ffn State:1a2
Phone No. Zip Code:
E-Mail: Phone No. LAoQ(Q WO
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) state or County License: e CL` k,6-210 1111
If value of construction 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•25U uQ t Address:
City: State• City: State:
Zip: loq Phone: to R Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not App licable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 appl y.
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
comment' work or recordi our otice of Commencement.
Signa of Owner/Agent/Lessee Sign re of Contractor/License Holder
STATE OF STATE OF FLORI
COUNTY OF FLORIDA,-, W-C'o COUNTY OF
The forgoing instru ent as acknowledged b fore me The forgoing instrume t was acknowledged before me
this day of tJ 20�by this day of 20_15by
C*aHl n dNar AC V=�J c�
(Name of person acknowledging) (Name of person acknowledging)
(Signa ure of NotJy Pub'N -Sta ef F ri ) (Signure of ota Pub' -S to for'
Personally Known ICOR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 's°"B%�;; (1"f-JIA DESTAFN mission No. "'YP +„ LSP-a&
��a::- " � SC715i�DESTAFNEY
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Revised 07/15/2014 (407)398.0153 FloridallotaryService.com (407)398-0153 FlorldallotaryServicexom
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