HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE.ACCEPTED
Date:TPermit Number: .%Or.
a".. RCEI`"gip JUN 2. 7 1016
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
Address: L' q
Legal Description: CL 1 01 lar V I I(AS C"d O
PropertyTax ID#: ® - 3 Lot No.
Site Plan Name: Block No.
Project Name: (0, Shares
Setbacks Front Back: Right Side: Left Side:
Room, a a
a =
PGi 2.0o
t =
PGT 20o s H I K
Additional work o be ertormed un er t is permit—c ec a appy:
❑HVAC Gas Tank Gas Piping _Shutters Windows Doors
Electric ❑ Plumbing Sprinklers F Generator 1:1 Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:-$. .29:3 34 Utilities:n Sewer[:]Septic Building Height:
� mln
Name StAS11A a V1 A 0 Name:
Address: -1460 S. Q 1)r' '120 if Company:
City: T State: F. Addre
Zip Code: 349 7 Fax: Cityi A State:
Phone No. _ (305) 120-$83 S- Zip Code: X34 S% Fax:51 1
E-Mail: Phone Uo.521- —7 —1D
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License:
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:
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 first i d to obtain financing, consult with lender or an attorney before
comme work o recordingour N tice of Commencement.
'771 E:::� s
_Signature of Owner ee/Agent Signature of Contractor/License Holder
STATE OF FLORID 1 STATE OF FLOID _
COUNTY OF 1, COUNTY OF `f�
TMtrb in ins r�t was acknowledge of e me The or oing instrument was acknowledge before me
ay of 20thi day of 20 by
o�� cu
(Name of person acknowledging) (Name of•person acknowledging)
ignature of Notary Public-State of Florida ) ignature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No O omm! sion No�
,q,�Yay MELISAARME �,
MY COMMISSION#r, 85382t p „c, cg= MELISA ARMENTO
h4Y COMMISSION#EE 855825
rYPIRM ecember28,20;F
Bonded ThN Notary Pu c n,er r
Revised 07/15/2014 BondedThruNo-yFONUndervmters
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS