HomeMy WebLinkAboutBuilding Permit Application �. ,ALL APPLICABLE INFO MUST BE COMPLETED,FOR APPLICATION TO BEACCEPTED
Date: Co . ay Permit Number:
0. ;I<.: RECEI�'�D J101N
Building Permit Application
Planning and Development Services .
22
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 linew t,nc�d�,� �G
Address:
'Legal Description: Q.n( , �O)l� Vjl)Q-s Ct111do
Property Tax ID#: Saa._ ��� Gd 13' X44 ^ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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= PC t 200 s H k�
Additionalworktobe ertormed un er t is permit—check a appy:
HVAC I I Gas Tank F]Gas Piping _Shutters E Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$� Z 93_5 Utilities:nSewer Septic Building Height:
SIR 11
Name Name:
Address: 7qbb a Y. q62 E Company: L S
City: J eps.en /'QacA State: rL. Addres
Zip Code: 309 1 Fax: City: —71 L Stat
Phone No. 1 $L4 - 37 1 g" Zip Code: Fax:
E-Mail: Phone No. 3—
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."
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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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or ur Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORI � � E''� � ��� � STATE OF FLOR D
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COUNTY OFCOUNTY OF
The for oin instru nt was acknowledged before me T f oing instrument was acknowledgL_dbefore me
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this day of 20-_L/ day of 20by
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(Name of person acknowledging (Name of'person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of otary Publi -State of Florida )
PersonallyKnown J OR Produced Identification Personally Known OR Produced Identification
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Type of Identification Produced Type of Identification Produced
Commission No. —���CS (Seal) Commission No. Se
MELISA ARMENTO
my ON#EE 855825
- EXPIRES:December 28,2016
Revised 07/15/2014 MELISAARMENTO
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REVIEWS FRONT PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 7r
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