HomeMy WebLinkAboutBuilding Permit Application (2) 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: To Select from dropbox, click arrow at the end of line
77-77777r7 11111111111IF--,
R91 E tQ► M �:
Address: S DCKS,-h• �'1 `�- \ • �� `� .L C
Legal Description:
Property Tax ID#: 0c)0,3 �� -- 9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
st
R IFK,
Additional work o e orme under permit ermrt—c ec a apply:
HVAC 11 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11ElectricM Plumbing OSprinklers Generator Roof
Total Sq.Ft of Construction: Ft.of First Floor:
Cost of Construction:$ 1,7, 6 Utilities Sewer F]Septic Building Height:
ow"WISSIM� 14TH i
Name ILS L RI S it ry B V Name: 11(:12K l v A 0(p Fi,
Address:f)CI l7 (S �2 )6 K S ,h S h Company:1 tS
City: \ �,tit C f— State:-l(. Address:9 h 12 S La [)n u L t &T—
Zip
iZip Code: Fax: City:'?0 V< S'% �U e:E Stater
Phone No. 1 c� - l7 L1 1.1 Zip Code: "3U 1i S 3 Fax: 'a b 4
E-Mail: ►v� lot Phone No. il`i� 6L( &I
Fill in fee simple Title Holder on next page(if different E-Mail: '%'" t 6 D 6) 0 u0-N
from the Owner listed above) State or County License: _ I U �)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
1 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 holds 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 r st t 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 our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contracto cense Holder
STATE OF FLORIDA STATE OF FLORIDA,
COUNTY OF_ ,�0. COUNTY OF c Lu .-Q
The oing in en was acknowledged before me Th forgoing instr ent acknowledged before me
this�jday of` 20 14 by this day of 20_" by
qyb
(Name of person acknowledge (Natlaie of person acknowledging Pj
R
V
gna ure of Notary Public-S e of Florida) ignature of Notary Public-Aili of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produr-A
fL_PJ�'
Commission No. o��"�p�••, L VNA INGRAM Commission No. `,,otic"' (Sea LASHAHNA IJA
Y p �.,
r*. ;" Notary Public-State of Florida g• .�s Notary Public-St-_•« . My Comm.Expires Dec 20,2018 s•„ -
� Commission #FF 177249 ��:4pf F�O•� � Commy
mission#��•• Bonded throw h National Notar Assn. '••R;;;;°�'R8V1Sed 07�15�29 � Bonded through Nation
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS