HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:0'1[05/2.QI lo Permit Number:_
I '
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 XJo,....-.__
PERMIT APPLICATION FOR:To Select from dropbox,click here
PROPOSED INPROVEMENT J~;G>CATION:
Address:ISlP W.ArbD Y A\lef1ue
Legal DescriPtionCK,ver J211rl6 -""\la',{i-'ELK '1-loT 5 (MAP 3LJ/Z'l sj
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Project Name:_
Setbacks Front _Back:Right Side:Left Side:_
I~PETAILED DE?CRIPTI0N 0F~ORK:'",.1
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CONSTRUCTION INF0RMAttON:
Shutters
D Generator
o Windows/Doors
DRoof
Total Sq.Ft of Construction:_
~f\o'OCostofConstruction:$_IVVV'-'--_-_
S~of First Floor:
Utilities:USewer DSeptic Building Height:_
~§>,WNER/LE~'$tE:
Name,~UOM'O
Address:ISh \1\.1.AiWY A\JerLue
City:"f>bY"\-&t.Lucre,State:FL
Zip Code:34OtS2...Fax:_
Phone No,172-340-3£:1(02
E-Mail:_
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
DESIGNER/ENGINEER:_Not Applicable MORTGAGE COMPANY:
Name:Name:_
Address:Address:-'--;:-:--:-_
City:State:City:State:
Zip:Phone:Zip:Phone:_
_Not Applicable
The for~oing instrument was acknowledged before met~77d'YOf ;ju'''lr .201,,,,lby
Uamf/el
FEE SIMPLE TiTlE HOLDER:_Not Applicable
Name:_
Address:_
City:-,.--_
Zip:Phone:_
BONDING COMPANY:Name:_
Address:_
City:_
Zip:Phone:_
_Not Applicable
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 structurewhichisinconflictwithanyapplicableHomeOwnersAssociationrules,bylaws o,r and covenants that may restrict or prohibit suchstructure.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
commencin work or recordin our Notice of Commencement.
Sig ature of Owner/Agent/Lessee
STATE OF FlORllifA U.'t'I ••COUNTY OF '-........"'){luc LUCt~
(Name of person acknowledging )"-
Signature of Contractor/License Holder
~~'1T~~Fcf~ORlrl{';1 Luc;eJ
(ignature of Nota7ub'-StatB..~ri!t~.l *f?h.~....••••••p;,.'/'
~~"~i-I'IRES '·.0-0
Personally Known o~@~~~~ntific'~
Type of Identification Producf31UJ:5!?:::.'";-~-E\.l-~~;;;.-_
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Revised 07/15/2014
REVIEWS FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED