HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Diviskil
2300 Virginia Avenue,Fort Pierce A :14982
Phone:(772)462-1553 Fax:(77 2)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address- U lis u
Legal Description:
Property Tax ID#: �� -- � -- �� —��,�^ ^T Lot No.�ca
Site Plan Name: \ Block No. rA
Project Name:
Setbacks Front sal:k: Right Side: Left Side:
INN=
AdClitional work to Da]Iormd uncler this permit—c ec a appy:
0HVAC Gas Tank ❑Gas Piping _Shutters Windows/Boars
Electric 14Plumbing E]Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: Sq, Ft-of First Floor.
Cost of Construction:$t1 4-D Utilities:05ewer OSeptic Building Height:
Name � Name• QJj,. lJ�A
Address 9u , �il`nS --�0.tf. Company:
City; State,��-, Address:
J�
Zip Code: _ Fax: �City.�` 1 State:,,
Phone No`I—) '� i- 6.a _I.' .691 Zip Code: " Fax-� ---)(Ztjy- 7�3
E-Mail: Phone Nel: aa.-cr
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:_.-N—kc C;)39
if value of construction is$2500 or mare,a RECORDED Notice of commencement is required.
4:
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 ha;commenced prior to the issuance of a permit.
St.Lucie Countv makes o representatl.m that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with ny applicable riome owners Association rules,bylaws or and covenants that may,restrictorprohibit such
structure.Please consul.with your Honie Owners Association and review your deed forany restrictions which may apply.
In consideration of the granting of this,equested permit,l 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,rences,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.
.L� r-.
signature ofoyOner/Agent Lessee Signature Contractpr/Li nse older
STATE OF FLORM rnSTATE OF FLORIDA (
COUNTY OF COUNTY OF Gz✓I h'-, yi?
The f ing instru ent was acknowledged efore me The forgoing instru n was acknowledged efore me
thisT".qday of .!0L02-by this 9nday of 20y
(Name of son acknowl in (Name of person acknowledging)
(Signature of Notary Pub�llc-.State of FIr-rida 4S gnature Notary Public-State of Florida 1
Personally Known `—bR Praduce� ode ication Personally Known'--4w s oduced Identifl tioi
Type of identification Pra1duceed Type of Identification Produced p ( ) r
Commission No.FFIm r *Expires
ALAN 8'
Commission No. �I�(�o�+ � 7 ✓�If� PUBLIC
N S,ADLVR
OTARY PL,19!IGTATE QF FLORt STATE OF FLORID
omn*FF182169Revised 07/15/2014 2/19/2019 Expires 2/19/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS [VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW EVIEW REVIEW REVIEW
PATE
COMPLETE
INITIALS
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