HomeMy WebLinkAboutBuilding Permit Application FALL`A.PIPLICABLE INFO MUST BE COMPLETED.;FOR-APPLICATION:TO BE ACCEPTED ' �nl n
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Building Permit Application
Planning and-DevelopmentServices
Building and Code Regulation Division
10
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::7!�-] I C) "',:5)_ ()LSCCom` o NCPA
Legal Description: .,Q nL-bo Itax- Villas Cron o
Property Tax ID#: --GO S - 0 o o a- o 0 Lot No.
Site Plan Name: I Block No.
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Project Name: S 41 I CLAI- ShQ MS
Setbacks Front Back: Right Side: Left Side:
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A onal work to be nertormed under this permit-c ec a appy:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric Plumbing OSprinklers Generator E] Roof
Total Sq. Ft of Construction: 'I S Ft. of First Floor:
Cost of Construction:$ y I�, l'T Utilities: Sewer OSeptic Building Height:
Ad
Name flomcls �Q 15 e r Name:
Address: `j
_ L)l0 ,S . DQeanDC'. 109__DCompan
City: 0-nsw IBQac k State: rte- Add it �-
Zip Code:_34957 Fax: City: I A State:-
Phone
tate:Phone No. 0-03 !414 -to 5 I(a Zip Code: L-VSF� Fax: - Z
E-Mail: Phone NQ
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work o r Notice of Commencement.
s
_Signatur Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FL OR STATE OF FLORIDA �^
COUNTY OF COUNTY OF
Th oing in ent was acknowledg d e re me Th r ng instrument was ac nowledg d before me
day of 20� th�y of 20 by
(Name of person acknowledging) (Name o person acknowledging)
(Signature of Notary
`Pubb _State of Florida ) (Signature of otary P blic-State of Florida )
PersonallyKnown " OR Produced Identification Personally Know OR Produced Identification
Y
Type of Identification ProducedType
�i Type of Identification Produced
Commission No. %&S b al) CD emission No. 5S 12,S (Seal)
MELJSAARMENT0 _
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Revised 07/15/20 ° . +d? EXPIRES:December 28,2016 j,x• r MY COMMISSION#EE 855825
J,;••.•oe• BandedThruNotMPublicUnderwriters EXPIRES:December 26,2016
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS