HomeMy WebLinkAbout Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p
Date: Permit Number: ��t)n-7
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Building Permit Application
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
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Address: Eck t _ 2)Vt ��e[.� 3 yg s
Legal Description: DLf pffq0/ : S _ r Lo JLAlb Y90
Property Tax ID#: 1313 - 5_Q D.-C6 5& " ODD _ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be De orme un er t is permit-c ec a appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 11 Plumbing Sprinklers 11 Generator F] Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer O Septic Building Height:
ii I No J41
Name
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Address: (pD5 U u Com an /L u«
City: , State: L Addre1ss: P,2(�. lJC9
Zip Code: 3 L11,51 Fax: City: USI- 1J
Wo L-r±L�J State:
Phone No. �--- 9. 1 b�-7�o Zip Code: 3)g j�eFax:
E-Mail: Phone No. .70 >-- 5 0I — I s)�-i l
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: Coc,
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:
1 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
commencinp,work or recording our Notice of Commencement.
s
_SignatOVORIDA
r Lessee/Agent Signature of C racto /License Holder
STATE STATE OF FLO A
COUNTY A1&41 91 VOL COUNTY OF 4yplm)
The for oing instrurpent was acknowledged before me The forgoing instru ent was acknowledged before me
this day of Ubt US 20 !(_by this 3 day of t1S 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known L� L
OR Produced Identification Personally Known OR Produced Identification
Type of Identification&PrdjpAVIp RAYMOND PRUE Type of Identification Produced
OTARY PUBLIC DAVID RAYMOND PRUE
Commission No. TATE(WO)ORIDA Commission No. NOTARY PU46�1)
omm#FF192675 �r G 1 y STATE OF FLORIDA
t ° Expires 1/26/2019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS