HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-- 1'7-7-f S Permit Number:
s
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 Yi
P, RC�}P®SED 1�11�PRO� NIEN,�TLATION: .,: .. ;
Address: J S6 80c/'cq,C
Legal Description:
Property Tax ID#: JY03 " 02' D 0 26 — 000 Lot No. Ll
Site Plan Name: Block No. �-
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Fy- S0qcncl ott /fircvaGy T P1,,ee- .
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CNSTRIJC�TION INF®RMATIONRr ,64 . .:. ..� e`
itiona wor to e e orme un ert is permit-c ec a appy:
HVAC �Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: l S Ft.of First Floor:
Cost of Construction:$ �Q Utilities:-—Sewer[]Septic Building Height:
DOWNER/LESSEE , rwC®N BRACT®R� m���
�.�xe
Name 8 eLV. O✓1 t� � o Name: cl�c�e�S
Address: ���rJ s (E; Q_'i tra1, i « Ve Company: + ��ine e-
�v�
City: QSL State: CLL Address:
Zip Code: 34 q OL4 Fax: City: R51 State: 1
Phone No. Zip Code Fax:
\ E-Mail: i Phone No.
ill in fee simple Title Holder on next page(if different E-Mail: rM MITL
the Owner listed above) State or County License:
"-+struction is$2500 or more,a RECORDED Notice of Commencement is required.
1
Sl1P`PIEIVIE(VTAL CONSftUCTI®N Lf.EN L�1UU"I. FORMATI®NMYr ..
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 refording our Notice of Commencement.
C;�JL s
g ature of Owner/Lessee/Agent Signature o n ractor/License Ho der
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF S .1,.1,GQ_ COUNTY OF
Theforgoing instru nt was acknowledged before me The forgoing instr ent was acknowledged before me
thisolr dayof 201J by this- day of Eee. 201J_ by
(Nam of person acknowledging) (Name of person acknowledging)
(Signa o Notary Public-State Florida) (Signature of Notary Public-St&e 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 SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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