HomeMy WebLinkAboutBuilding Permit Application a
ALL APPLICA LE IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. �d� 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
PR®=FO'SEDIM�PROVEMENT LOCATION K ``
Address:
Legal Description:
Property Tax ID#: f�-F 42— �.� — ��J— �— 1 Lot No. C
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i DETTAILE® DE`SCR"IPTI`O'N
bNrc `� � w C9-ef�Va+v 66Y T-:r
CONSTRUCTION INFORMP►TION li
itiona work to . e e orme under this permit—check a appy:
UHVAC E]Gas Tank 0Gas Piping _Shutters Q Windows/Doors
-----Electric 0 Plumbing Sprinklers 11 Generator E] Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction.$ Utilities: Sewer O Septic Building Height:
®WIVER/LESSEE CONTRACTOR
�'
Name Name:
Address: , 2 Company:
City: State: Address: Ed
Zip Code::J� (�Z Fax: City: State: T 1
Phone No �— J�� — ��,(p Zip Code:, Fax
E-Mail: Phone No. Z
Fill in fee simple Title Holder on next page(if different E-Mail: _ C,. L cc yY1
from the Owner listed above) State or County License: ( llD�k3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL,CONSTRUCTI.ON LIEN LAW INFORMATION;
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: TNot 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.
o s
*Siatuf Owner/Lessee/Agent Signature on rac or icense er
old
r
STATE OF FLORIDA STATE OF FL RIDA S
COUNTY OF l `�_ COUNTY OF J LUNG
The for oing instru anent w acknowledge fore me The forgoing instru ent was acknowledged fore me
this day of 20 shy this x day of 20' by
( ame of person acknowledging v (Name of person acknowledgingaw\,i,f�- a.",A,
)
I
f Not r Public-State of Florida) (Signature P blic-State of Florida)
Personally Known OR Produced Identification Personally Know R Produced Identification
6. Wde roduced Type 6
Q&&tiwPro ed
Comrr ��0.YP '. AN6� ,HUFF Comm
iission No.
tary Publi t to of Florida 1 ',a _ �Sfg 0r ia
Commisslon#FF 234730
OP P: IIIIII 1 �p��g�, t d
17F F� Bonded through National Notary Assn.
I � ��
Revised 07/15/2 ..
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS