HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE INFO MUST BE COMPLETED 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
�ry
Address:, 2 2&JJ 14C)LL0d.0 -bVor
Legal Description:
Property Tax ID#: Y 71)5 oll , t)0o ,I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwork toe nerformed under this permit—check all appy:
❑H AC 0 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric ❑Plumbin (�S rinklers ❑Generator ❑ Roof
g El P — —
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:0SewerF ]Septic,,,,. .Building Height:
51
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TWO
Name Name.
Address: f ZC _ " Company: NNo1J TiIC
City: S LcCI State: Address: & 91--_97 e
Zip Code: L Fax: City: LLI>:. Stater
Phone No. '7X-) Sc t� ( �� Zip Code: 919P) Fax: 7,(?-Zia-&n(-
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: R,4 e_AQ1_s Z&K
from the Owner listed above) State or County License: 2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
„-
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.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF U�c,t� COUNTY OF � -11A c.,)t
The forgoing in ument was acknowledged before me The forgoing i strument was acknowledged before me
this)Z5 dayof rn�J - . . 20 Eby this L day of C. m 20__t1->by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of o ary„,M, ic- 8 ESHER (Signature* - Florida
1a°`�v P�B`� Notary Public-Mate of Florida ,,o�........
"Y°. •
SALLIE WILSON ES ER
Personally Kno • . Q�, I AD
j Persor.ail Not8ftftudu l jfAa on
Type of Identi - ce Type of Id �4t� c '�ri�21StV*•Expires
- s ��;••' Commission#FF 148194
Bonded Through National Notary Assn. 'ov Fl°
"����""� Bonded
Commission N Commissi Thraugh,National
Revised 07/15/2014
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