HomeMy WebLinkAboutBuilding Permit Application·'
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ 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: �() �YelA\1 cJ,
PROPOSED INPRO\lfMENT LOCATION: . s
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Address: L01'2E5 Ql ua.tv1v I/A ()vc.,,lL, 1 Fov+-Q.e,vce_, 1 FL-- �2-
Legal Description: ¥1 Q[Y) q,A),('€ . Sf D BL\l E U:)1 LO
Lot No. _
Block No. _
Back: Right Side: Left Side: _
Property Tax ID#:-------------------------
Site Plan Name: ------------------------�
Project Name:---------------------------------
Setbacks Front _
j DETAILED DESCR1Pi-!0N OF WORK:
\DStl\. \ \ B?J' Pl) l P « \ k x:;rd., �ON
Mechanical
Electric
Gas Tank
_ Plumbing
_ Gas Piping
_ Sprinklers
t at app y:
Shutters
Generator
_ Windows/Doors
Roof
Sq. Ft. of First Floor: _ Total Sq. Ft of Construction: _
Cost of Construction:$ �\&7i��:'2._�----- Utilities: Sewer _ Septic Building Height: _
Address: &, ( J-5· /.J:l.<.¥':P\Jl)( 1A'
,,,, c
City: 1Qr-< -fl.I e/ee..
Zip Code: 5'1'9 8'J-- Fax: _
Phone No. ,?J. -(;.16- 3a:7C.
E-Mail: --------------�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mai� �-t@'.6J trfJ(Lwfao( RLlfki� ·
State or County License_�10\�_,_�_.._._ ............ _
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
_ Not Applicable DESIGNER/ENGINEER:
Name: ------------------� Address: ------------------ City: State:
Zip: Phone _
MORTGAGE COMPANY:
Name: _
Address: ------------------- City: State:
Zip: Phone: _
_ Not Applicable _Not Applicable FEE SIMPLE TITLE HOLDER:
Name: ------------------� Address: ------------------ City: _
Zip: Phone: ------ ------------
BONDING COMPANY: Name: _
Address:------------------ City: _
Zip: Phone: _
STATE OF FLORI�\
COUNTY OF M CA.L?
ontractor as Agent for Owner
STATE OF FLO��\ COUNTY OF ,,\.,L�
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 irst inspection. If you intend to obtain financing, consult with lender or an attorney before
work or reco in our Notice of Commencement.
The �g()ing instrument was acknowledged before me
this day of roc1t3 , 20-U.P by
The :6:going instrument was acknowledged before me
this day of s,.,JAY\JL , 20� by
Personally Known OR Produced Identification� Personally Known OR Produced Identification _
T f Id t.frE!i__. tl Type of Identification ype O en I · I STEPHANIE BROOKS fr�����==���!!!!!!bJJ� P d d YCOM" Produced ''r;,,"''\,<\".""'''•,,.,,.... ·-
ro uce , 1VilSSION#FF217128 · ,�"·tt·.,:- S1EPHANiEBROOKS
EXPIRES: April 5, 2019 t*{ ,/- ·A MY COMMISSION# FF 217128
Commission No. Notao;PublicUnderwrilers Commission No. ------·i.fz .. ·W(Seat}PIRES: Aoril 5 2019
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COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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