HomeMy WebLinkAboutBuilding Permit ApplicationBUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
772-462-2165 or 462-2172
FAX 772-462-6443
AUTHORIZATION FORM FOR CREDIT CARD PAYMENT
TO: St Lucie County
Permit #
Credit Card Users: 1.5% Surcharge added per transaction.
Payments must be received in this department by 4:00 PM for transaction to be
processed that day, if not it will be processed the following business day.
VISA MASTERCARD DISCOVER
Credit Card Number LAO 9 TY L-1040 Og'19 _ �� 14q
Expiration Date �' q _ Zip Code 4 ,
3 digit security code` 56
Amount $ Wrvy-tib- , . + 1.5% surcharge
Business Name: ���[� C,
Authorized Signature: kA
Print Name: _ L -m (-v -( -ha tw - -
Phone: (1 1'o„ r'�
Fax: 3�j 1l
Comments:
SLCPDSD Revised 2/14/2013 EN
. L -C
IN
ALL APPLICABLE INFO MUST BE 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 )C
PERMIT APPLICATION FOR: ' To Select from dropbox, click arrow at the end of line
Address: 10 96 1 s f CQCe ►n isYZ l5
-6e-Y16en (?>26LCX x�j— 3'�q
Legal Description: rt_
� AMI �1 � ��11� � ��' i►�e-�a{ l
Property Tax ID #: l I ` i O - aC)-�3k- 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
.
DETAILED FCfiP;10 OF 'OR,
�xI(XC 5� r !C ! r , 2 "YYIt +� i�•�, J i L r 1 SLY SC's' t i GLi rYt 1 i�►�! M11 'YYi�J% t'IR7 �. .
Q Y1G� A 4121 ur,(kL�f' $ Cc L- im �1 X � l IC Ili �L� IC_ t} �C� S`t ►'��s
HVAC
0 Electric
Plumbing 0Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ `� 0,b0 ?'bO
L.=.1 Shutters
OGenerator
S. Ft. of First Floor:
Utilities: Sewer Septic
Name 'sct o-ve-S
Address: 5 1 S, DC Q.L: n D -C, S
City: P 1�a2�1 )P'2.0&P_0\ State: -
Zip Code:,`;iLAA J 9 Fax:
Phone No. c11_l U -- ` '�r� "' � Q
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
l__J Windows/Doors
0 Roof
Building Height:
Name: T-Y-Lv 11> 61 YIer-
Company: Ca UDS_ �Or�lC1L�
Address: L0`a�7 <Su f"), LTMD'f`2
City: 9/3cr'`* LQ1 C' LJL_ State: N -
Zip Codes _-_-7)LA4 Fax:
Phone No. 7.7 a -9 -71 S1nO
E-Mail:&V_ UU' lC_rt_ � Lt tLIKY�I�
State or County License: CQ�_' 7 to ori
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable 13ONDING 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 thepermit 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
commencinA-vvuirk-or recordftig-VoLir Notice of Commencement
S
_ Signature of Owner/ Lessee/Agent Signature of ontractor/License Holder
STATE OF FLORIDA
COUNTY OF` b cv
The forgoing instrument was acknowledged before me
this J�r day of—t— l�- 20 j by
(Name of person acknowledging)
CJS MULL I CJ LL &
Signature of Notary Public- State of Florida )
Personally Known OR Prod tification
Type of Identification Pro �,BTHE
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E
Camrnis5i0n No."YR LININA IE BOUCHARD
, a. .,;::
a MY COMMISSION VF125526
EXPIRE$ May ;ei , zo1 e
{007) �5t7-0151 %lidallotarysery ce.eom
— ReviseJ.07/1S/201f.!
STATE OF FLORID,�1
COUNTY OF f� Y
The forgoing instrument was acknowledged, before me
this 1 a ay of 1�(}'(1 20 by
��t:�'-& CAU ,
(Name of person acknowledging)
(Si ature of Notary Public- State of Florida }
Personally Known OR Produced Identification
Type of Iden r#laq,l\/,.i P:,csscr
LINDA MARIE BO CcH D
Commission N : �_ ISSION #�F�g
EXPIRES May 21, 2018
3t13 r"vi ivarvurgryJerylce.cum
REVIEWS FRONT ZONING SUPERVISOR PLANS
COUNTER REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW