HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COQv5MPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit{Number:
Building Permit Application
Plonning-orid Development Services
Building and Code Regulation Division.
2300Vir91nfa Avenue,Fort Pierce FL 34982'
Phonef(772)462-1SS3 Fax:(772)462-1578 Commerpal, Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the and of line
Address;
Legal Descri tion
Property tax ib#: i "' O .r ' �[/ � Lot No
Site Plan!Name: __ ! _ Block NO.
Project game.
5etbacks Front Back: Right Side: Left Side-
CUT.(
ide:
CUT.
cn
it r►a wor to e e orme un er is U.perm —c ec a appy:
HVAC Gas Tank Gas Piping _.Shutters ❑Windows/Doors
Electric L1 Plumbing ❑sprinklers Generator Roof
Total Sq.-:Pt of Construction: S .!Ft.of First Floor:
Cost of Construction:$ C Utilities:-Sewer septic Building Height;
Name Name.
Ad ess�i ��Q,� &OR—MN 12 '1 Company:
Ci State rT Address:
ZE
Zip Codi ,� Fax: CityC1 1--� State: -
Phone Nd:�"I�' 22(Q •L4a QZip Cade: Fax'
E-Mail: PhFbne No.
Fill in fee simple Title Holder'on next page(if different E-Mail:
from the Owner listed above) state ounty License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNP;R ENGINEER: 'Not Applicable MpRTGfieE COMPANY: _Not Applicable
Name: Name:
Address:! ' Address:
City: i _ State City: State:
Zip: _Phone: Zip;_ Phone:
FEE SIMPLE TITLE HOLDER. _.NotApplicable BONDING COMPANY- _Not Applicable
Name: NaEne:
Address:' Address,
City: City:
Zip: Phone• zap; 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 pwners 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 as; that i will,in all respects,perForm the work
in accordance with the approved plans,the Florida Bullding 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 roars and accessory uses to another non-residential use
WARNING TO OWNERS Your failure to Record a Notice of Commencement may result in your.paying twice for
improvements to youf'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 recorcl[nn voiur Notice of.Commencenient.
I
Signature bf Owner/Agent/Lessee Signature of Contractor(License older
STATE 0 COUNTY,OFORIDA - �J - COUSTANTY
OF FLORIDA
COUNTY OF
Thepng instrwment was acknowledge fore me The f,grgoing in r meet was acl ngwledged I;efore me
thisday of ZO by this• ay of ! 20bY
I
(Name of pers n acknowledging) (Name of person acknowledging
(Signature of Notary P lic-StW o Florida) (Signature of Notary Pub'c- tate f Florida j
Personally;Known OR Produced Identification Personally Known OR Produced Identification
Type.afldentification Produced Type of Identification Produced // �
Commission No. p (Seal) Commission '7 4&-3 (Seal)
MAR
IE GRUZADO
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Revised 07/15/201 y *' MYCOMtA13810N*EE19r489 ='� MY COMMIGSKA10HE11 MW
ayiRES,Wne 25.2078 EXPIRES June 26,20
REVII=INS FRONT 'ZONING ,SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLEf E
NiTIALS
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