HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I NF!iO� S COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` Permit Number:
- 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
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Legal Description: Yo .- y'Jn IJ r(/ Ooh,, Unil A , Lai :233
Property Tax ID#: 1 )`I nco -Co) -000 na Lot No. CM
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e former un lert ispermit-checkall appy:
HVAC 1.Gas Tank OGas Piping _Shutters Windows/q99$__
OElectric O Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$�91• Utilities: Sewer Septic Building Height:
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Name U / Name: es'b r)CIA — ��icaly er'
Address: S L Company:--F-4_(n 00I�Q£�
City: {� State:EL Address: %::�4 in 1 `75 im 1?I— A�
Zip Code: s Fax: City: L-0 State:_
Phone No.-7 7a� 7�o f'-t j 11 Zip Code:33L1 I g Fax: 5-61 .MS'S S•q05-
E-Mail: Phone No..' —/- tc5 • eq
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 0 (0 0 lo 3['
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 recording our Notice of Commencement.
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_Signature of Owner/Lessee/Agen a ure ofContractor/License Holder
STATE OF FLnaw
STATE OF FLO A
COUNTY OFOR �CL c h COUNTY OF � M 5l?GtG 6
The fring instrument was acknowledge before me The for oing instrument was acknowledgedbefore me
thisday of_. 20 by this day of J�l h ,20 �by
1 .J •l
(Name of person acknowledging) ( ame of person acknowledging)
IT ignature Notary-Publicc--Stat f Florida) (Signature of otary Pub'c-St a of Florida)
Personally Known ✓ OR Produced Identification Persona yKnown OR Produced Identification
Type of Identification Produced Type of Identification Produced
AN13ELA YOUNG .. .�,Y.daNGELA(SYp9�NG
Commission Neer' : ��S Commission No. = AiiflAiSSI®lT10E9B8835
q'O�EAI ISSICR E188835my
,9 EXPIRES April 12,2016 EXPIRES April 12,2016
(407)398-0153 FloddeNoteryseiv'ice.com (40Z 398-0153 F1addallo1er1_- C—
Revised 07/Yi72
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