HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PE�QP;OS���IVIPROVEMENTI.,OCaTIaN ,, _ _ 'y y '4 j
Address: 17� �p� �. �' �� ��•
Legal Description:�tvt!i0�r�-�ntrt5 �.54 1..t7�'��
Property Tax ID#: 3`1►°1-�wG-O � -GGU-8 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
x
it�ona wor to e e orme un er t is permrt—c eck a app y:
aHVAC Gas Tank alias Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers a Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ����� Utilities: Sewer Septic Building Height:
CIWNER�LESS�E r
CQNTRACT
Name AA9, Q, nA n Name: - <�
Address: 116 S �a �o.�,�t'- Company: h t►n It'x
City: `('r)r �i..t� State:• Address: 3I h (� 0 1
Zip Code: -Sy'% 3o 1 4 Fax: City: `Bre' S'•Lr_-%4_ State:
Phone Noln—'618-tL�Z Zip Code: 34Fax:11
E-Mail: Phone No. Z j-1914111
Fill in fee simple Title Holder on next page{if different. E-Mail: 1 &� )n ��
from the Owner listed above) State or County License: C�C, 4
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:
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 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 inspectio . 'F you intend to obtain financing, consult with len r or an attorney before
comm4cing work or r,466rd'ing your Notice of Comm enceme t.
1�5ignature of Owner/ nt/Lessee ignature FT Contras or/License Holder
STATE OF FLORIDA ` STATE OF FLORIDA ` -.-
COUNTY OF COUNTY OF
The forgoing instrumQnt was acknowledged before me The forgoing instrument was acknowledged before me
this l qday of 20 by this day of_ v'-��' 20 by
(Name f t ckno- ) (Name of p ea0 k"p` � h)IISSIONl�EE181893
MY COMMISSION NEE181893i .
' .. EXPIRES May 05,2011 EXPIRES May 05,,2016
a +07,J9"163 FWMNof eMea.eoea
dU7139&015� P1pAds etvicro.edm - �
(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. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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