HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Q,\ Permit Number. `P
Date: !�_\
RE CEI�'7D.�P; 217.016
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Residential
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S q b
PROPQSED IMPROVEMENT
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Address: In
Legal Description: 61
/ D Lot No.
Property Tax 1D#: `
Block No.
Site Plan Name:
Project Name:
Setbacks Front /0 Back: Right Side: (� Left Side:
77
DETAILED DESCRIPTION,®F W
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CONSTIiUCTID INFORNiATI
Aciciitiona wor to e e orme un er t .is permit-c ec all app y:
HVAC Gas Tank [:]Gas Piping _
Shutters ❑,Windows/Doors
®_Electric 0 Plumbing Sprinklers �Generator
a Roof
Total Sq.Ft of Construction: ~?.U S .Ft.of First Floor:
Utilities. Sewer0 tiSepc Building Height:
Cost of Construction:$
;OVUNFR�LESSEE:: _
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Name ' �� ' /r Name: �` G
Addre ��i Company:
ss: �`� �
City: -� i�l��L°/'I State: Address: –Y ���f�`
State:
Zip Code: a. Fax: City:
–^ _
Phone No.
Z. � Z Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: � —
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City. State: City. State:
Zip: Phone: Zip:
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 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
cornirponciWwork pr recordinR our Notice of Commencement,
LZ LIZ s
Signature of Owner/Lessee/Agent Sfgnature oftci-ntractor/LicenteHold-er-
STATE OF FLO
JtJDA. STATE OF FLORIDA
COUNTY OF -=1 T . I-x)c. COUNTY OF '5 . � �l;Zj
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this'Q,\ day of!!,".
20 S by this QA day of 0, 20 V by
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(Name of person acknowledging) (Name of person acknowledging)I
(Signature of Notary PuW-State of Florida) (Signature of Notary PublW-State of Florida
R_ m V ed OR Pr Personally Known
Personally Known 5;9P Aa — 16 Qn,,.ma
P 0 U��e " El -
1kc-stake
!on Produce Type of Identi
Type of Identification flcatF07TfrrrCJk16
EE 858761
Commission No.IZ11-�Ivl%lj�&"oMo We\'alls�_ Diary N101V Commission No. Assn.
h WIWI,
Revised 07/15/101
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION 5EATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE