HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE-INFO MUST:BE COMPLETED'FOR APPLICATION TO BEA CCEPTEDl _
Date: L �D Permit Number:
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Building Permit Application
Planning_and Development Services
Building and Code Regulation.Division /
2300 Virginia Avenue, Fort Pierce FL-34982 V
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line�_u-
Address: -7L4Q0 �, O� �� � , 0 BlLp
Legal Description: �O)IQ�' b , I asl.l�Y1C.�(D
Property Tax ID#: aa � Lot No.
Site Plan Name: (� Block No.
Project Name: SOX, I ICU- 5 60 r(2,9
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit–check all that app y:
HVAC GPiping Shutters
Electric Plumbing 1:1Sprinklers El Generator 1:1 Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ -.3 . Utilities:ESewer Septic Building Height:
Name J Q,S d' ( 9_n ISQ, VIS Name:
Address: 7 4 20 S, peg n, )r: g Ito C Company.
City: -_U–W1SW 6g C_h State: Address:
Zip Code: Fax: City: \ Stater
Phone No._ _ Ca! q Zl - 3.91 I Zip Code: ,�'SS Fax: –7�t`�j
E-Mail: Phone No. — C-
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.
DESIG _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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencingw r In o tice of Commencement.
s
_Signature of Own essee/Agent Signature of Contractor/License Holder
STATE OF FLORID12 STATE OF FLRI A
COUNTY OF COUNTY OF O[Y1
The for oln ins t was acknowled before me Th j�going instrun en was acknowledged before me
thi day of 201�by this=- >day of 20�by
zq_�\ C_VXt� `l
(Name of person acknowledging) ame of'person acknowledging)
nature o otary Public-State Florida (Signature o otary PPuublic-State of Florida)
Personally Known OR Produced Identification Personall Known OR Produced Identification
Type of Identification Produced AA cation Produced
My COMM SSION#EE 855825
Commission No. b (Seaog EXPIRES:Pe6ftrsshiel (Seal)
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Bonded Thru Public Underwriters
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y. g EXPIRES:December 28,2016
Revised 07/15/2014 ,;f•••- , Bond edThruNoWPubrxUnderwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE �
INITIALS I`