HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 06-661lS Permit Number:
• RECEW'D SEP 3 0 ZO
iblimo 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
PROPOSED IM`P'ROUE'MEN1' LOCATION:
m .
Address:
Legal Description:
Property Tax ID#: �L-V,0- �t'�— C WA- QFC�--0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
a DETA'ILEDD`ESC�RIPTIbN O`F WORK
q 4 "VF St fiY� .1
CON�STRI'JCTIO NFORMATION:
Additionalworkto� ae orme _ un 'er t is permit-c ec a appy:
HVAC Gas Tank OGas Piping Shutters Q Windows/Doors
gElectric O Plumbing OSprinklers O Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
.�r oo11 LnJ
Cost of Construction: $ �, 2 � Utilities.. Sewer _Septic Building Height:
kOWNERJLESSErE ' r a CONTRACTOR r
Name Name:
Address: ' - - 1 Company: C,
City: State: Address:
Zip Code: Fax: City: ,vState: �r�-
Phone No. l2- 3�,���� Zip Code:��-Y �O z- FaxI1 r': -��.Lus
E-Mail: Phone0 9.32
Fill in fee simple Title Holder on next page(if different E-Mail:No,., D
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
FQRr M Tg IN ', -UPLEMENTAOlRlJGTIO LEN LAV
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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. 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 our Notice of Commencement.
s
_Sig re of Owner/Lessee/Agent Sign re of Contractor/License Hol er
S LTECOUNTY OFORIDA STATE OF FLORIDA
a
1LaCCOUNTY OF
The for ing inst ment was ac cnowledged before me The forgoing inst ent was acknowledged before me
this�y of 20'�by this day of 20 1� by
� YUS Ill (�ao
(Name of person acknowledging) (Name of person acknowledging)
K02-
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 7 —�P a ion N ���,�aa Z
Notuy POW-State of Florida �,� s �PWft-Std a
.xC0111110MRIMS FF 28111
�=:o, •-"9�, �,°��CommhWN 0 FF ?31665
My Comm.Expires May 31, 19
My Comm.Expires May 31,2019
Revised 07/15/2014 ''� OF t� ,- Bonded through NationalNotary Assn. `" " Bonded tlxouo Uatlaal ttOtary sn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
COMPLETE
INITIALS