HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit t�urttber.
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Building Permit Applicatloh
Planning and Development Services
Building and Code Regulation D;Wsion
23001rrgink Avenue,Fort Pierce FL 34982
Phone;(772)462-1553 Fax;(772)462-1578 Commercial._ _ [residential
PERMIT APPUCATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description: Url 04 SUM Ouh
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Property Tax iD Lot No.
Site Plan Name• >$lock No, Ra
Project Name: ',
Setbacks Front___,___ Sack: Right Side: Left Side: i '
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ork to be nerformedunder ts perms --c ee all t=apply-
HVAC --•• Gas Tank as piping _Shutters []Windows/Doors
C1Electric LSI Plumbing DSprinkler's Generator Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
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Name Name-, (1 6
Address: Company
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City: ROW V- 1,(1—e Stater Address,: 162D A17' 'Eb. Meaiwer(2
Zip Code: Fax:`-77Z_3qS= 7f) City:�C�1(' State•
Phone No. -"' ` ""Ct�`'7:Z� -- Zip Code: • Fax:` Y'7L-�Gef-G-q-7
721
E-Mail: U9f 12fEY�t G �'DdYIL°tX S .I � Phone No, e �"
nil In fee slmpleTttle Holder on text page(if different E-Mail; ''',T l .�
from the Owner listed above) State or County License:•�
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTG/�GE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:.__
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER; _Not Applicable BONDING COMPANY: _m 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 orrecordtWyour Notice of Commencement.
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Signatur ner Les ee/Agent Signatu//Z
rttra io' License Holder
STAT ORID� ST FLORIDA '
COU TY OF } Z- is I•e COUNTY OF ` 4V4 tai
The forgoing instrument was acknowledged before me The foreoing instrument was acknowledged before me
this 13 day of .��, = 2020 this ��-�. day of •: ���J 20 Ito.••by
(Name of perso acknowledging) (Name of perso• ackri'owledging)
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(Signature of Notary Public-State of Florida) (Sig ature of Notary rublic-State of Florida)
Personally Known V/ OR Produced Identification Personally Known v` OR Produced Identification
Type of Identification Produced Type of.Identification,Produced
QD Se ae_e0ISTINALLOU'DEREACP
commission No. YF 9� Yom. fission Ivo- H!"CD9� �'% tSTINA L LOUDEFLACK MY COMMISSION#FF 229
MY COMMISSION#FF 922 reXPRES 7
eXPIRES August 7,2ot7 388-at P,3 FloritleNolary9eevic0.c
Revised 07/15/2014 1a97l398.0153 Fi0dd4NotM80N1*9.com
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DATE
COMPLETE
INITIALS