HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 (LI
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Permit Number:
Planning and Development Services Building Permit Application
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, ---------------
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Address: J� f
Legal Description:
Property Tax 1D 4h
Site Plan Name:
Project Name:
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Setbacks Front --4 Back:
___, Right Side: _� Left Side:
Lot No.
Block No.
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HVAC app WMN
Gas Tank []Gas Piping `Shutters Windows/Doors
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Plumk�rng 0$prfnklers OGenerator
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Total Sq. Ft of Construction:
_ { S Ft. of First Floor:
Cost of Construction: �'
Utilities: SeWE!F oSeptic Building Height:.
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Address: A
city: c-1 Pk -p-re .
- State: —
Zip Coder t - SDC) Fax:
Phone No. 1 _7,;� - DSS — '
E -Mail:
Fill in fee simple Title Holder on next page iif different
from the Owner listed above)
Name: JDeXV t
Company:'
Address: _ ! #State:
U`r'-{��-�-'City Off`-i#�-
Zip Code: tS Fax:Phone No.
E -Mail:
State or County License: C Q
If valve of construction is $2_500 or more, a RECORDED Notice of Commencemer+t is required. `
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FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
_Not Applicable
Name:
REVIEW
Name:
Address:
REVIEW
Address:
City:
State:
City:
State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
INITIALS
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
5t. Lucie County makes no representation that is granting a permit will authorize thepermit 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, 1 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
comrnencinor recardir�vaur Notice of COmmencement.�---r_
_ Signature of Owner/ Lessee/Agent I Signature
STATE OF FLORIDASTATE OF FLORIDA), ,,,. _ A
CCOUNTY OF
COUNTY OF �( l'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I I day of "kSA- 20 LL by this li day of ,c J- 20 1e_ by
(Name of person acknowledging J (Name of person acknowledging)
(Signature of Notary Public- State of Florida -( ig ature of Notary Public- State of Florida j
Personally Known '� OR Produced Identification Personally Known [�'_ OR Produced Identification
Type of Identification Produced Type of Identification Produced
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1.';'S1Y Pv nr V P
Commission No. , LIN{�,alli�ARIE SOUCHAR Commission No. ** LINDA MAI 91J6UCHAAD
MY COMMISSION #FF125526 ` = MY COMMISSION #FF125526
Revised 47/15/2014 1(407)39&-0153
('i07)3g8-0153
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS