HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB E IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l� Permit Number:( ^ C ) t
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
Address: LOW
Legal Description:
Property Tax ID#: Do(-)(-) 06)0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/V L1 l./ 't . 9 .�'M 1 1-%-In
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itional work toe nertormed under this xpermit—check all that appy:
❑HVAC 0 Gas Tank Das Piping _Shutters ❑Windows/Doors
_Electric ❑ Plumbing []Sprinklers ❑Generator!, ❑ Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 21�, Utilities:cn Sewer❑Septic Building Height:
TAmn
Name _ Name: Vohl:
Address: ��(� lU. y1ly >: Company: MON. 0 �C-
City: l� l i _Cir_ State: Addr ss: cV QFF d>
Zip Code: Fax: City: ��"�, (.t cCl� State:.
Phone No. -77d -q4,1-V
U Zip Code: 40cp7 Fax: 7742- -lc
E-Mail: Phone No. 72J-- IX/' RV6
Fill in fee simple Title Holder on next page(if different E-Mail: I LI 9 (R AOL, 6901
from the Owner listed above) State or County License: 2022
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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�'ME;1,
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.
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Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA�� STATE OF FLORID
COUNTY OF Cl� ,.XCA�. COUNTY OF Q< �
The f rgoing insoment was acknowledged before me The f oing i rument was acknowledged before me
this)f day of11C4_rv�b`�` 20� by this day of C. 20_11,by
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(Name of person acknowledging) (Name.of.person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) p
,,p � yP DnSNER
Personally Known ro ugh Personally Known .•� �#'qd
Type of Identificatio Type of Identification ' = o ar u c- a e
N •= My Comm.Expires Nov 2,2018 i�9f �a;� Com �s o FF 14819plies 4
Commission No. :9 0:= Comm(6 �4) FP 14819 Commission No. %PFF�O`` go�����ionalNotaryAss
Bonded Through Natio^V Noi
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS