HomeMy WebLinkAboutBuilding Permit ApplicationALLAPPLICAIJLEI FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� �• Permit Number:
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Legal Description:
�)IcrCe 3�
+e i 0 e -4/U .:3.,5 -loh
Property Tax ID #:t �` f��'. �Q��� D ' Lot No.
Site Plan Name:1 ��Block No.
Project Name: [� U,01 � m Pict I p
Setbacks Front Back: Right Side: Left Side:
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Ad
nal work to be ertormed under this permit — check all apply:
NMVAC F] Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
11 Electric 0 Plumbing ❑Sprinklers 0 Generator Roof
Total Sq. Ft of Construction:((((yyyy S Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer Septic Building Height:
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y : = z,+ 3,c'+s;
V ERS/I:ESSEEd
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.
Name
Name:
Address:
Company: S 1'r) I' f'�1,O�1d15
City:e_ iGf Cel State: f
Zip Code: 5 Fax:
Addr s: ,55
City: oxt'no -chState:
Phone No.-7TZ— `J— Qb
Zip Code: :5300c) Fax: qtD—q_ (O”
E -Mail:
Phone No. 924 — �S3 on
E -Mail: R�rO In S 01 In Ct yyytn cli r .Q) M
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name: _
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
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, perforin 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 ins ton. If you intend to obtain financing, consult with lender or an attorney before
commencing woFtc or Yecording vour Notice of Commencement. ,
Revised 07/15/2014
REVIEWS
FRONT
ZONING
S
_ Signature of Owner/ Lessee/Agentigr
e a ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The fpygaing in t,w,a acknowledge¢ before me
this Qday of VtfbT— 20 `�by
The f�rgojp9 instr t s apknbwiedged before me
this `((/day of ��'-(' 20 iia by
REVIEW
REVIEW
(Name of person acknowledging
(Name of person acknowledging)
DATE
(Signature of No ub ' -Stat of Florida)
(Signature o o Publi tate of Florida
Personally Kno n 1?rodu � i�
Personal o iPA,produce en i tea to
' °=
Type of Iden io
Type of i entificatio P TAMMY ZIESAK
• =
Commission No. =;�° '�,- My Co E P11res Aug 25 2018.
q
;, • s� : otary Public -State of Florida
Commission No. -v ;`Y_ My Comm,�c�les Aug 25, 2018
,,. Co n # FF 137G�9
„oF�. Commission # FF 137629
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS