HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:Wm M
n RECEIVED.iUN 2 4 7606
Building Permit Applicati®n
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 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ,b,�,0 , mo
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Address: 1
Legal Description: Sm& IO IIar v I I GS `8•no .
Property Tax ID#: �J °� �3' O� 0� ®d�_ l Lot No.
Site Plan Name: -- Block No.
Project Name: Sand\\Do CX Shgp rQS
Setbacks Front Back: Right Side: Left Side:
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Additional work toa er orme under this permit-check a t appy:
HVAC E] Gas Tank Gas Piping1:1 Shutters Fq-Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ �_,aq 3.3� Utilities:12Sewer []Septic Building Height:
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Name D� Q Name:
Address: '7 y30 .�C'er�n�(. L412 3 Company.
City: Tamw Clk State: RL Addr
Zip Code: 3`'9 Fax: City-, State
Phone No. C Z03 1) as Zip Code: Fa x
G y-3- 25
E-Mail: Pho no I
Fill in fee simple Title Holder on next page ( if different E-Mai
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or our Notice of Commencement.
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_Signature of Oessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FL RIDA /I� �1
COUNTY OF COUNTY OF Y
T �pqping i rrtsti u1 ent was acknowled d efore me Th or oing instrument was acknowledg before me
t day of 20� y th1�day of 20 by
(Name of person acknowledging) (Name of'person acknowledging)
Signature of Notary Public-State of Flori a ignature of Notar7011
State of Florida) .
PersonallyKnown OR Produced Identification Personally Known Produced Identification
� kation y
Type of Identification Produced" .� Type of Identification Produced
CommissiZl (Seal ME �i N (Seal)MEUSAARMEMO
_' �= MY CAMMISSION#EE 855825
CO ISS #EE 85 2016
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EXPIRE :December 28�erwriters o EXPIRES:December 28,201 ers
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 1r
COMPLETE
INITIALS