HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I" 2n 2_DJ LP Permit Number:
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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
Address:i4 l Ll
L es p on:
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Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
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Right Side: Left Side:
Lot No.
Block No.
W�) -Lt W
1 �
A I na w J o e erforme un er is permit - check aIf appy:
HVAC Gas Tank F]Gas Piping_ Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ "- D Utilities:cnSewer Septic Building Height:
Zip Code: t) ( I M --r Fax: � I
Phone No. 4n �' LOA • f)Pxi 4
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Zip Code:
Phone o.
E -Mak -
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
_ Not Applicable
MORTGAGE COMPANY:
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
Not Applicable
FEE SIMPLE TITLE HOLDER: _ 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 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
commencing work or record g ur Notice of Commencement.
Signature of Owner/ Agen / Lessee Signature of Contractor/License older
STATE OF FLORIDA
COUNTY OF
Th ing instpe�jwal acknowledge�efore me
thi day of NI (�i� 20 by
(Name of Pers Elcl dging )
STATE OF FLORIDA a ��� 1
COUNTY OF 1"� 1 �-+'
Th ng instr t a ac nowledged before me
this<�ay of 20 y
A-( l
(Name ofrson acknowledging
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(QpPub,�kt(ateaf
) (SigPub c -(Signature of Notao Stateyforid�TU
Personally Known
Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission N EI!L(Lall Commission Ndi'�)
CRYSTAL MARIE CRU CRYSTAL MARIE CRUZADO
?' COMKni�aww +► et �u1ISSI9rF#EE„r�4W
Revised 07/15/2014
EXPIRES June 25, 2018 f4f",, -0�33 EXPIRES June 25, 2018
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS