HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
OR
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 l/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Property
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Property TaxID#: � 1�1"5)!1� 'C71L�'U�t`� �7 Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to (epe orme under tispermit–checka appy:
11 HVAC L__I Gas Tank ❑Gas Piping _Shutters F—] Windows/Doors
Electric L�Plumbing Sprinklers a Generator F] Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ 1 3 Utilities:Sewer Septic Building Height:
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Name MN-M Name: �>M
Address: Company: '�� �M ►r� ��h
City: State: Address: 31 In tirlwa
Zip Code: Fax: City: Rnr ' �*-Lv,ot State:_b_1
PhoneNo._JJ"V %19—OS90 Zip Code: 34034 Fax:1111`$31-90M
E-Mail: Phone SNo. Z" M vi1
Fill in fee simple Title Holder on next page(if different.. E-Mail:1 1F ,i+ l"
from the Owner listed above) State or County License: CE C, N4L U 01
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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900/T002 XVd TT:ZT 9T09/90/T0
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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 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 inspectigill If you intend to obtain financing, consult with lender or an attorney before
con3mencing wo c,6rcling your Notice of Commencement.
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1gnature of Owner Agent essee of re ofCorI1ra(Ybr7License Holder
STATE OF FLORIDA 1, ;,> STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledgedp. efore me The forgoing instrument was acknowledged before me
this (_r day of :_h' ; 20 1 .>by this —day of ..i a.;'} 20 ,by
1
(Name of person acknowledging) (Name,of person acknowledging)
(Signature of No,lary Public-State of Florida} (Signature of"Notary Public-State of Florida)
Personally Known ° OR Produced Identification Personally Known ` OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ""`:%�.j 7� Beal) BEOiK1f TAIL �nmis !on Noe_: �:=��'. i 'c::`�qAy (S OIISIf �
_.. Tri �®'�'
AAY COMMISSION# El 1693 My COMMI88ION#EE1.$9
05 ?Qle.
Revised 07/15/2014 C°"' 53 Fl�ri/��y s•�+«.con,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
900/Z00 n XVA ZT:ZT 9TOZ/90/TO