HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date- Permit Number.
Z. -4112f'07-JIS411--VN�--i'
Building Permit Application
Planning and Develapmetlt Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)452-1555 Fax;(772)462-1578 C mercial Residential V
PERMIT APPLICATION FOR: ToSelect itom ropbox, click arrow at the end of line
Address:
Legal pescription. Nub Ba�Are8
Property Tax 1l)#, Lot P40,
Site Plan Name; Block No.
Project Name: Ldryuld
Setbacks Front Back; Right Side; Left Side:
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XHVtAC
alworktol:enertormecl undert its permit—Enec a ap y.
Gas Tank Das Piping Shutters 11 Windows/Doors
0 Electric Plumbing LISprinklers t. i Generator Roof
Total Sq. Ft of Construction: Sq,Ft.of First Floor.
Cost of Construction:$ 17'0 Utilities-OSewer Fleptic Building Height.-_
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Name.Udw Up(V'0- Name: F-1
Address:-'Ia Company: �r)&fir`
City: State- Address:
Zip Code-- 6E51 a--9 Fax--2na-9`2 2-'-2 city: YbYbA- L0 f-4 P-- —State: Ff�
Phone No. 5f'S?2—QlZ� Zip Code: Fax-�3 -1?72Z�
E-Mail- Phone No.
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Fill in feesimpleTitle Holder on next page(if different E-Mail:
from the owner listed above) State or County License:
If value of canstrurtion Is$2500 or more,a RECORDED Notice of Commencement Is required-
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DESIGNER/ENGINEER: _Not Applicable 'MORTGAGE COMPANY_ _Not Applicable
Name: Blame-
Address: - - Address: ---
City: Stater City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name- Name:
Address: Address:
City; city:
Zip: Phone: I Zip_ Phone,
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Counter makes no representation that is granting a permirt will aut prize the permit holderto build the subject structure
which is In conflict with any applicable Home Owners Assacfatlgn 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 5t.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,s een rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Noti a of Commencement may result in your paying twice for
improvements to your property.A Notice of Comrr encgfnent must be recorded and posted on the jobsite
before the first inspection-lfi a intend to obtain financing,consult with lender or an attorney before
commencing k or recopdjfig Vour Notice of Commencement.
1� S
SignK10FRIDA
Der/ see/Agentir�� Signal ractor�4c a Holder �G�y�,
STA ST' F ILORIDA
COA � C��: CO OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Zoltiy this °daV of Zo by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of N ry P lic-State of Florida) (5ignature of k ' Puublic-State of Florida)
Personally Known r✓ OR Produced Identification Personally Known OR Produced identification
Type of Identification Produced_, Type of Identification Produced
Commission No, f"837G5' (Seall Commission No. �ny,� (Seal)
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Expire*:JAN.15.2018 �WWWAN0*brAFffACMEJAIV.15�'%A18
NornR�oomRevised07/I5/20L � o
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW RI=1IlEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS