HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I FOM ST BE CWOPLETED 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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Legal Description-
Property Tax ID OOC).Z Lot No.
Site Plan Name:t�-'-!'tom( t- )2:z r-9- Block No.
Project Name:_ -D&
Setbacks Front Back: Right Side: Left Side:
eckal[ apply:
HVAC Gas lank ❑Gas Piping _n Shutters 2`windows/Qp=s--
Electric 0 Plumbing Sprinklers 1:1 Generator Roof
Total Sq.Ft of Construction: SQ. Ft.of First Floor:
Cost of Construction:$ Utilities:0Sewer Septic Building Height:
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Name Name:
Address: /901/ LA3 Company:a-�L-(o 00 QI
City: F:t - State:F' Address: V,� (.p 4 -7_9 7!b o
Zip Code:3 V 19 8- Fax: City: CJrN- -State:
Phone No. Zip Code:3SL4 I DL Fax: 51,114710
E-Mail: Phone No. ss-
Fill in fee simple Title Holder on next page if different E-Mail:
from the Owner listed above) State or County License: a2k-F5 3
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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UPP EMENY !.CD S R CTiQN Lt�N LAW IN
DESIGNERjENGiNEER: `Not Applicable MORTGAGE COMPANY: __ Not Applicable
Name: Name:
-' Address: Address:
City: State: City: State:
f Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
1 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 withyour Home Cvvners Association and rroview ybur.tleed 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 'rst inspection. If you intend to obtain financing,consult with lender or an attorney before
commeoCinP,work or recording r Notice of Commencement.
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Sign ature_oCQwnerj+lessee/Agent S' ature of Contractor/License Holder
STATE OF FLORIDA - -STATE OF FLO DA
COUNTY OF S IAC LZ OFry-) RL02L� _
The€o� o'ng instrument was acknowledged.before me The forgoing instrument was acknowledged before me
this-r -f day of ^rG't E
20 by this rday of. ✓ JQ If- 20 1,5:-by
gMe S 0- 1 S
(Name/6 pe on a kn wle gi g (Name of person acknowledging)
(Signet, e o Nof Putijc State of Florida j (Signature o atary ublic-Stat f Florida)
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Personally Known OR Produced Identification �� Personal y KnownORProduced Identification
Type of Identification Produced— -AL Type of Identification Produced
F I l David E. n
Commission No. f�!tn}'n
Notary p b`ri$ missio No. .a ,, o NGE�A�UNQIm
p'State of FA MV COMMISSION#EE18883s
' nes ' •y.aw EXPIRES April 12,2016
Revised 07115/2414
(107}398-0453 FlMdallotarySemice.coo t
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS