HomeMy WebLinkAboutBuilding Permit Application.,3PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: /
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
3ERMIT APPLICATION FOR:
Address: _
Legal Description:
Lot No.__
Property Tax ID #: Block No.
Site Plan Name:
Project Name:
Back: Right Side: Left Side:
Setbacks Front ,
Z' 1h S" �on /s"' �.S�rl C/AnSe
rtiona work to be pertormeu u11,
Mechanical _ Gas Tank
permit all that apply:
Gas Piping —Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Sq. Ft. of First Floor: _
Cost of Construction: $
�—
� Utilities: Sewer Septic
/� S��-
Name
Addre s:
City: A, State: /`
Zip Code: S� Fax:
Phone No. � l v
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height: ___.
Name: C ucbs Sa-mrnon S
Company: ILI� Lc S4S f e M S 1L1 C
Address: IS S �- �) i 1(0e � Q ren D, -City: VcQT i Luc kc- r State: �L
Zip Code: 34 �S)- Fax: TU .)3S 12L
Phone No. 7 7,2 33,5 -3a3 2"
E -Mail: C r Gc L cfi
State or County License: Cfl D5 ►R l0 � Sal
If value of construction is 2580'or more, a RECORDED Notice of Commencement is required.
e
Not ApplicalDie
Name:
Address: State:
tate:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Address: State:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Name: Address:
Address: City:
City: Zip: Phone:
Zip; Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 aby,aow5 or and covenants thatt mayd the
sttrict or structure
s ch
which is in conflict with a%applicable Home Owners Association rules,
structure. Please consult with your Home Owners Association and review your deed for any restrictions
rf the workh may
In consideration of the granting of this requested permit, I do hereby agree that I will in all respects, p
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
for
WARNING TO OWNER: Yourfailure Notice a Notice of Cor nit must be recordednervt result
uand posteour d Ing twice
j for
site
improvements to you property.
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recor ' •ur Notice of Commencement. ^ e
11111, 101
Signature of Owner/ Agent/ Lessee
STATE OF FLORIDA /
COUNTY OF
The forgoing instrum, nt was acknowled0ged before me
this . day of
(Name of person acknowledging)
2
(Signature of Notary P blic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced oe CHRISTINE B. E
' c * MY COMMISSION 0
Commission No. « ° * EXPIRES: April
`"r"'"� Bonded Thru Budget Nc
REVIEWS FRONT ZONING S REVIEW R
COUNTER REVIEW
DATE
COMPLETED
Signature of Contractor license Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instr ent was acknowledged before me
this ,J, day of �� 20= by
(Name of person acknowledging)
(Signature of Notary Pu ic- Stat Florida )
/
Personally Known OR Produced Identification
Type of Identification Produced
f
CHRISTINE B. ENGUSI
SH C �G� �(� *)MY COMMISSION a EE 8592
8MMmission No. EXPIRES: Aprilk 2017
1, 2017PLANS VEGETATION SEA MANGROVE
REVIEW
REVIEW REVIEW