HomeMy WebLinkAboutBuilding Permit Application A4,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
MOM
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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Address:
Legal
Proper.ty Tax ID#: -000- Lot No.
Site Plan Name: Block No.
Project Name: AP,-D e'r, FY
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Setbacks Front Back: Right Side: Left Side:
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HVAC �Gas Tank ❑Gas Piping _Shutters Windows/Qoors
Electric �Plumbing Flprinklers Generator Roof
Total Sq.Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction:$ r,� 3Q Utilities:11 Sewer Septic Building Height:
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I i/P Name:
Address: I 10(0 . L_11 a-
Company- .1--co
City: Rx W Jk/ State-- Address: 13 4 (P 11 -75 T-H
Zip Code: CJ -7 Fax: City: I,t)��_k vti',Pvec--�Qj-, State:
Phone No. A s 3-0 3 2 Zip Code:31L) I ;)i— Fax: 5_Ll ,'8�_5•qO
E-Mail: Phone No. ;57.At--
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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DESIGNER/ENGINEER: u Nat ApplicableMORTGAGE COMPANY: Y Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _____,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 Counter 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 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:roam 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.
S
_Sigr<aEure of Owner/Lessee/Agent ature of contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF P.-t( _"'-c d COUNTY OF x'511-n 5'Pr,irA
The forgoing instrument was acknowledged before me The fgrgoing instrument as acknowledged before me
this day ofTsvr r�. 20 J�'Fy this ( day of_ 20 _J_T�by
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(Name of p on acknowledging) (Name of person acknowledging)
(Signature of 'otary blit-State of Florida) (Signature o ata Public-State Florida)
Personally Kn n�� ++++8 OR Pradu a Ihlc %ta142426
Personally Known OR Produced Identification
Type of Identi :e Type of Identification Produced
Commission N =�, •oma; My Corxrn.Ex res''yy��
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iuMISSION r EE1888 5
,lijp. " EXPIRES April 12,2010
Revised 07/15/2014 E9;+;''R'
(407)398.4153 FloridallotarySfirvice-conl y
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS