HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:am
Permit Number:
Planning and Development Services Building Permit Application
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462.1578 Commercial
PERMITAPPLICATION FOR: Residential '\
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Address:
Legal Descnov tin W6 I,n---I� Cy"`�ye T- �PrY o tG Tu
Property Tax ID #:
Site Plan Name: (7 3 - Ud0 -y
Lot No.
Project Name:
Block No. _
Setbacks Front Back:
Right Side: Left Side:
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Total Sq. Ft of Construction: c+L Generator Roof
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Sq. Ft. of First Floor:
Cost of Construction; $
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. Utilities: 0Sewer Septic Building Height:
Address: + Name; -
City: ;iN'r 'PI ,v:^s� ompan
Zip Code. Hq6 l State:!- Address:
Phone No. -1 Fax:
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E -Mail: Zip Code:
Fill In fee simple Title Holder on next Page H Phone Nc
from the Owner listed above) p g (. different E -Mail: _
State or C
more, a RECORDED Notice of commencement
Fax:
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Name:
Address.
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Name: — - ----
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
which IS IA [OIfII1Lmt with aA, applicale a Home Owners tAssociationl rulelsabylavvn 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
commencina-workor recordiDgVour Notice of (Tmmen a e «
_ aignamre or Owner/ Lessee/Agent
STATE OF FLORIDA �ft S+ LL k t e
COUNTY OF_
The forgoing instrument wasacknowledged before me
thisday of LLS 20lia-by
N/a/m�e of person acknowledging )
STATE OF FLORIDAP�� �, + S4 l �A�
COUNTY OF
The forgoing instrument was acknowledged before me
this' day of n LA61I.Yt- 20 !to by
(Name of person acknowledging)
-•-•- •• •��_ taignature or Notary Public -State of Florida )
Personally Known OR Produced Identification_ Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
.m.
Commission No. rs":!ih''1 1.11,10 yjARIE SOUCHAR Commission No.
MY COMMISSION #FF125528 OA NtAI(�E�bg�12
1 MY COMMISSION +
Revised 07/15/2014 HCn Na�piAl FKKpa aErviw.roT Nana Js, FwwaNMa gI,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
INITIALS