HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J /
Date: / 5 �
Permit Number:
Planning and Development Services Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Pax: (772)462-1578 Commercial �
Residential L.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow�t the end of line
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tir1 �
Legal Description:
Property Tax 1D#: _
Site Plan Name: Lot No.
Project Name; ` n �, Block No.
Setbacks Front Back: Right Side:
Left Side:
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i na or o e ei orme
un er t is perm-—c ec aapp y: :�^�,.� ; _.. • , :,�ys�#i�����, ;a,,�,`...;' ���
HVAC Gas Tank Gas Piping _ShuttersO �Windows/Doors
Electric Plumbing Sprinklers
Generator � Roof
Total Sq, Ft of Construction:��� .
' _ S Ft. of First Floor:
Cost of Construction: $
Utilities; Sewer liseptic Building Height:
4 v ry a.
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Name
Address: Name.
Company: c
City `
Address:
Phone No
Zip Code: � Fax: State,
�t City:
� , _ State:
Zip Code: Fax-����P( ( nil
E-Mail: A4 I
Phone No.
Fill in fee simple Title Holder on next page{ if different E-Mail:
from the Owner listed above)
State or County License,
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 TITLEHOLDER: _ 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
impcove ments to your property.A Notice of Commence ent must be recorded and posted on the jobsite
bef a the first inspection. If you mend to obtain financi ,consult wit lender or an attorney before
com encin w din r Notice of Commenc ent.
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Signat a of see Sig Yu o Co tra ice se Wold
I
COASTAT O O ,� STA E OF O
COU OF ;�' 7 ,. e_.
The forgoing inst ent was acknowledged before me The fo oing ins t was cknow dged before me
ti 1 day of�Qy0(� 20 11 by th"May of 20Ily
*-�aA\V4 \, ,eff( ,A LPa�A
Mame of per n acknowledging) ( ame of person acknowledging j
gnature of No ry Public-State of Florida) Si ure of Notar ublic- tate§ Ida ) JERALYNNE RUSSELL,
* . = Nct'V�'Public-state 01 Flori
Personally Known P pR Prody � LI #q Personally Knowncf�y�tfti�a#i�p ELLP L i��� 20
Type of Iden tifica - d n o,loo p„ht -S Type of Identification Produ d';Po ^o `' Comrrtisslon FE n�,a392
" otnm.Expires Jul 22,2017
Commission No. _'Acga4 FF 038392 Commission No..C- - �$@a
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS