HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE FO MLI T BE COMPLETED.FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Applicati®n
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
Legal Description:
Property Tax ID#: � C) do Lot No.
Site Plan Name:: Block No.
Project Name:
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itiona wor to e e orme un ert is permit–c ec a app y;
C�HVAC �Gas Tank ❑Gas Piping _Shutters �Vl/indows/Doors
Electric 0—Pum bingSprinklers Generator Raof
Total Sq. Ft of Construction: Sq-Ft.of First Floor:
Cost of Construction:$ a LI-5 Lo Utilities.0 Sewer Septic Building Height:
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Name1 cl10E 1� '� 1L: 1ZL�,��_ �. Name: � Ul t;t )�'�rCLjiE �
Address: q bo l0-VI_• M.Gt1 e l) a, (31Company:Company: `!2C A50? &)A-5T- Al IL L i.iU�tTt aRu
City: 1)YL Guriell) State:_�- Address:. -R 0. 30V c I tpa
Zip Code: { Fax: 1413 L11b - 1335 City: � �> Bxi -I state: �=
Phone No. 14U ) - LA 1S "7'-[1 Zip Code: 5 QCOO) Fax: -772.-335191c)4
E-Mail: Phone No. "713- V1n' 1101
Fill in fee simple Title Holder on next page(if different E-Mail: i�'ft-L(9C4 D 9 N71-1 MEh—
from the Owner listed above) State or County License: �' 05g)Q-Kp
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: T 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 Counttyy makes no representation that is.grant ing 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,l do hereby agree that 1 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 (ender or an attorney before
commencing work or recording our Notice of Commencement.
_Signa Owner/Lessee/Agent Signabureiaf Cptractor/License Holder
STATE OF FLORIDA " ( STATE OF FLORIDA
COUNTY OF ,`�2-r int COUNTYOF �4&g-T1
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 -15�by this RD day of 100" M413 X—, ,20 t5 by
(Name otperson acknowledging) (Name of person acknowledging)
•;�.� C� n'`b elf, -�� ��_�-�.�-�.mt..1'�----- .
(Signature tory Public-State of Florida) {Signature ci4 ary Public State of Florida)
Personally Known Y" OR Produced Identification Personally Known.__OR Produced identification
Type of-Identification Produced Type of Identification Produced
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�.�.. �o�f"avvB� y' ADAi111J
JIQ1' iJ ADAMS Commission No. r,(i, 1
°•••'t' `°:'mss r�Iii 6 ^- `Co on k FF 907740
Commission No. -a a.
--- .a Com �ssi n k FF 907740 My Commission.Expires
My Commission Expires r,,;�«°• January
moi,t o
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS