HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
-3 --_�- 3 - ii (o 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: Other
Address: � 5 0 b . LULL 41 , •�-- LU
Legal Description: �� �Gl I'1C� by�k`J � ndomt n i
Property Tax ID #: X3'5 — L&) .- COW 'Lw ! Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
10 K �-\J
3 -MN t0al-eASou.rl,
Additional workto ej orme under t Fs permit — check all apply:
aHVAC L_!I Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
Electric ❑ Plumbing O Sprinklers a Generator Roof
Total Sq. Ft of Construction::���
Cost of Construction: $ C71Iboc D _
S Ft. of First Floor: _
Utilities Sewer 1:1 Septic
Name Name:
Address: 75n of ��� DI'(032- Company: Q
City: �'T naQ n lice 0-h State: rL Address:
Zip Code: ,34 CIS 3 Fax: City �iha a
Phone No. Zip Code: g5 3
E -Mail: Phone No. '17J
Fill in fee simple Title Holder on next page ( if different E-Mail:Drit_121 b
from the Owner listed above) State or County License: _
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Building Height:
'nix fi
MORTGAGE COMPANY: "Not Appficable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: v Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: v' Not Applicable
Name: _
Address:
City:
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 your Notice of Commencement.
e6vessee/Agent
STATE OF FLOR�D�p (
COUNTY OF IVB I.�
The f oing in fie, .w�1 acknowledged .before me
this day off . T (�Y 1 20 jaby
(Nam f person acknowledging)
(Signature of Notary Public- State of Florida )
i
Personally Known 1r OR Produced Identification
Type of Ide -
Commissio «- TCOMMISSION 46M*4048
`'•,,a EXPIRES July 31, 2019
Revised 07/15/2014
-s
Vie- a0or/License Holder
STATE OF FLORIDA
COUNTY OF
The fo oing inn was acknowledge before me
this- day of� 20 Up by
4u Dix
irn �n
(Name o erson acknowledging)
0 G",� f
ka-6-0
(Signature of Notary Public- State of Florida)
Personally Known Rf—wood•IdoGtiflGdtin�
Type of Identific eCRYSTAL A
My COMMISSION � # FF904048
Commission No.EXPIRES 1 X0)1, 2019
(4C/)J9&Q'S� F$oridalloiaryServlce.corr
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
T
T