HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �I�1
Date: Permit Number: Z& 0 IRECEIVED
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Building Permit Application
Planning and Development Services APR 0 2o�s
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential r/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description: w QQ.A`er Qaj-k A Alk �-no
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Property Tax ID ##: �)ga6 - D:p 00G a ---060 -a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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STRU.CTION`INFO:RMATI:ON:. <<.;:� .:.,;•;`r
Additional work to be nertormed under this permit-checK all uUt appy:
aHVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
OElectric 0 Plumbing OSprinklers O Generator FA-_Roof
Total Sq. Ft of Construction: x855 Sq. Ft. of First Floor:
Cost of Construction:$ /a�Jr�O,00 Utilities Sewer 0Septic Building Height:
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Name 7h -ocl arc D40M Name:
Address: r 2 9/V Company: all /4qm fi -6kl
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City: �--�, / 2rC-� State: FL ' . Address: � 1AS A.uv
Zip Code: ?���$/ Fax: City: l�-/, �i P�C'Q, State: EL
Phone No. 76 6- C[g0 S,?Ll J Zip Code: py Fax:
E-Mail: Phone No. _7'7,;�- L1&C/- G ta()
Fill in fee simple Title Holder on next page (if different E-Mail: rt n;-kr mal( CirP0.r-no4viq , n on i
from the Owner listed above) State or County License: G I Q&I l-7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUAPIEM, GTl*0N1!"lJ4 BN%.� 00 V A.--_.CQNS:'�g
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 App licable
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 appi y.
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 i obsite
before the first inspection. If you intend to obtain financing, con ult with lender or an attorney before
comm work work or reOrding your Npfteof Commencem
SignNa-f'ure of Owner/Agent/LesseeSignature of Contractor/License Holder
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STATE OF FLORIDSTATE OF FLORIDA
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COUNTY OF COUNTY OF
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The f r oing instryment was acknowledged before mel ig The f9r
,going InstrumAt was ackr.Twledged before me -a
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this day of 20 2 9?by thisay of 20A by �rn M
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(Name of person acknowledging) of person acknowledging 6;
N&Jnure of Notary Public-State of Florida) (1'igja)tre of Notary PuMic-State of Florida
Personally Known OR Produced Identification Personally Known L-" '011 Produced Identification
Type of Identification roducead
Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS