HomeMy WebLinkAboutBuilding Permit Application ALL APPLIWLE INFO MUST BE COMPLETED FOR APPLICATbN TO BE ACCEPTED
Datel,/4,l Permit Number:
Building Permit AppliCation
Planning and Develol Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commdrcial
Residential
�zri 3M e it 3
PropertyTax ID#: Q')Z3 060� Lot No.
Site Plan Name: Block
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Ad t onal woryr k to be performed un•er tHis permit—check all that apply:
■
OHVAC F]GasTank FIGas Piping ■Shutters F—]Windows/Doors
Electric feTPlumbing ]Sprinklers FIGenerator F� Roof
Total Sq. Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction $ Utilities. ]SewerF_Septic Building Height:
'Address:
•• City: 0 ir-�- State:
Zip Code: Faxl:) TI N—V100
�Phone No.
E-Mail. VNI
'State or County License:
if value of construction is$2500 or more,a RECORDED Notice of 6mmencement is required.
08/04/2015 14:55 FAX Z002/003
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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:
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I certify that no work or installation has commenced prior to the issluance 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 rales;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 grope A Notite of Commencement must be recorded and pos the jobsite
before the irst inspectio o intend to obtain financing, consult with lender or a orn y before
comm work or r din our Notice of Commencement.
gna ure of ner/ gent/Lessee ..gnature o Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA j
COUNTY OFfOUNTY OF
The f going instrument was acknowledPPH hefore me
The forgoing instrument as acknowledged before me
this day of 1201 S_by this day ofS`6Y
(Name of person acknowledging) ((Jame of person acknowledging)
(Sign✓ of Notary P-6 tate -lorida} (Signatu Notary Public-S a Flo; a)
Personally Known y ri Identffication Personally Known�_OR•Pr ftp0fZg1&?q
Type of Identificatio P.FARC1 Type of Identification Produced: .
MY COMiON#FF165172 EXPIRES(�ct ber 1,2018
Commission No. 10 - •? Commission No. I ea�
e XPIRE October 1,2018
Ui;,3 Florltla otary eNlce.com
407 398.0153 Floridallota Service,com
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS