HomeMy WebLinkAboutBuilding Permit Application ALL APOLI LE INFO MUST BE COMPLETED FQR APPLICATION TO BE ACCEPTED
Date- Permit Number:
RECEIVED MAY 2 6 7016
Builditig Permit AppliCation,
Planning an JDevelopment Services
Building and ode Regulation Division
2300 Virgin' lAvenue,Fort Pierce FL 34982
Phone- (77 462-1553 Fax:(772)462-1578 Commercial Residential
PERM
ITARPLICATIONFOR: To Select from dropbox, click arrow at the end of line i%.C\C—
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�Address:
Legal Des'crip on.
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Property Taxi #: Lot Nol:i M0
Site Plan Na Block No.
Project Name
Setbacks F nt_ Back: Right Side: Ldft Side:
A
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Mian wk td be 0 rformad under his permit-check a ill t=apply:
A.. Gas Tank []Gas Piping [JShutters a Windows/Doors;
OElectric L J Plumbing QSprinklers Generator Roof
Total Sq.Ft.-..of onstruction: S . of First Floor:
Cost of Constr coon:$
Utilities: SewerSeptic Building Height:
Name
Addre
City: ie. State:
Zip Code: Fax: city; state:2(-
PhoneNo. Zip Code: 'Sq SZ�-_ FzX: Cal
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Fililinfee sirn Title Holder on next page(if different—
from the Own r listed above) State or County License:
If value of con uction is$2500 or more,a RECORDED Notice of Commencement is required.
,
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DESIGNER/f: GiiiiEER: Not Applicable
MORTGAGE COMPANY: �Not Applicable
Name:
Address:
City: State; City: State:
Zip: 1I Phone: Zip: Phone:
11 FEE SIMPLE` ,ITLE HOLDER: �Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: IL Phone, Zip• Phone,
I certify that nc work or installation has commenced prior to the issuance of a permit.
St.Lucie Count .makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con ct with any applicable}tome Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Pleas consult with your Home Owners Association and review your dead for any restrictions which may apply.
In consideratiot of the granting of this requested permit,I do hereby agree that l will,in all respects,perform the worts
in accordance v'th the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following b ilding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory strut ires,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING Ta OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
imp ovemen to your property.A Notice of Commence ent must be recorded and posted on the jobsite
bef a the fi t inspection.if you 'mend to obtain#inanci ,consult wit lender or an a Corney before
com encin din r Notice of Commenc ent.
Signat re of v e 5ig re o Ca tra ice se Hold
COV ' O O `� � S7A E OF OR1QRrl
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The forgoing i trum nt acknowledged.before me The forgoing rostrum was acknowledged before me
this-Z!day 20 y this `day of to y
Vr Lmd'
Na o rs ackn I dging) {Name of son acknowled i I
Signa ture o tary Public-State of Florida 1 R tura of Public-State of Florida
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,,� Y A` on Personally Kno n n�'� '" . Pr enti Hca '
Personalty Kno �R Prac1�4 + pj. _ 9t , RUSSELL,
Type of Identifi _ 'eedotary g1401«-sra+�I,� Type of I ant if n c
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