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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date- y� rp — Permit Number. iii d 1 RECEF-D AP° 217016 *11 mm 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 .:....... .... . PR ®:POSED IMPI?DVEMENT LOC�,TION Address: Legal Description: Lot No. Property Tax ID Block No. Site Plan Name: Project Name: Back: Right Side: Left Side: Setbacks Front L07777,7777777777 77 DETAILED ®ES777777777777 .CRIPTION Xx 00 or fie'c4l 9v . C ;f�STRtJCT1ON IN .6k.0 TIORI: ' .. Itlon2 worK t0e pet 16,me under t Is permit-C ec t a at appy (=..1 : ❑ HVAC t Gas Tank ®Gas Piping Shutters Windows/Doors ®Electric El Plumbing Sprinklers Generator Roof Total Sq.Ft of Construction: (a oS .Ft.of First Floor: Utilities Sewer ElSeptic Building Height: Cost of Construction:$ 01NNfRLESSEE Name Gti I CGt (./PA`e, I.. Name: G S Addressu� (� _ 6` !� ,,-Company: : ©• �.City:t��`1 ��� State: Address: Fax: City:` State: Zip Code: ��. Phone No. �- 3���� Zip Code; Fax- E-Mail: Phone No. J Fill in fee simple Title Holder on neat 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. .......................... WRLE DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:• Not Applicable Name: Name: Address- Address: City. State: City: State: Zip: Phone: Zip: 'Phone: 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 commencing work or recording your Notice of Commencement. Signature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORI()A STATE OF FLOTnA COUNTY OF COUNTY OF 1-13 C_�­P, The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this 7.1 day of_�t 20 Eby by this�day of CM 20 by (Name of person acknowledgird) (Name of person acknowledging (Signature of Notary Pub*-State of Florida) (Signature of Notary PublilO State of Florida NS Personally Known V\da - -OR PFro. e b Personally Known _ORP duce' onin6da Type of Identification Pi:qdu-e X__ Type of Identificatior6-RP-rod c ­,-V, 206% P 0 IT Commt `PC°cCOO m•ExP�res EE 858765 Commission No. 01 Commission No. t rt� t°naiNotary Assn. 41,1�&_11 Revised 07/15/2014�-`:;�� REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW - REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS