HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE IMFtsT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
10 Date. 1` • Permit Number: / DZJ
Building Permit Application
Planning and Developent Services
Building and Code Reg '!anon Division
2300 Virglnla Avenue,fort Pierce Ft 34982
Phone: (772)462-15$3 Fax:(772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
I
Property Tax ID M- I Lot No.—
Site
o. --_Site Plan Name: Block No.
Project Name:
Setbacks •FrontBack: Right Side: Left Side:
ip
work r t s permit—c ec all apply:
HVAC W Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers O Generator Roof
Total Sq.Ft of Construction: 8 Ft_of First Floor:
Cost of Construction: Utilities:l_J Sewer Septic Building Height:
Name Name:
Addre S. Company:'
Cit state. Addre s:
Zip Code, Fax: Ci State:
Phone No. Zip Code: Fax:
E-Mail: Phone No.
Fill in flee slmple Title'Holder on next page(if different E-Mail: Wke
from the Owner listed above) State o ounty License.
if value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable 7rass7
E COMPANY: Not Applicable ,
Name: '
Address: I _
City: i State: City: State:
Zip: Phlone: Zip: Phone:
FEE SIMPLE-TITLE H LDER: _Not Applicable BONDING COMPANY: _Not Applicable i
Name: 1Name:
Address: ! Address:
City: I City:
Zip: Phone_ _--- __ Zip: Phone:
I certify that no work or nstallation has commenced prior to the issuance of a permit..
St.Lucie Coun makes n representation that is granting a permit will authorize the permit holder to build the subject structure
which is in convict with a y,applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult ith your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the nting 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 exemptfrom 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 yo ("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
cammencin work or record" ur Notice of Commencement.
Signature of owner/Ageh Lessee Signature of Contractor/Licens older.
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I i'1 i COUNTY OF
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The eIng Instr I e n wledge efore me Thef r oing instr e c ledged before ire
this day of 20 &y this day of 20�y
l ffil i l
(Name of person ackno• ,edging) (Name of person acknowledgin )
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(Signature of Notary u -State of Flo 'da) (Signature of Nota`ry/Public-State of Flo Ida � ,.
Personally Known OR Produced Identification Personally Knowny OR produced Identification
Type of Identification Pr duced Type of Identification Produce �—
Commission N•o L� Commission NBOM
+ CI;tY$TAL MARIE CRUZ 30
CRYSTAL MARIE RUZ'ADO 63
ION N IEE1974G3 EXPIRE$Ju1M 23,21►
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REVIEWS FROM' ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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