HomeMy WebLinkAboutBuilding Permit Application 1 •
ALL APPLIC; 3LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date 1 Permit Number:
REC IVED
Building.Permit Application AUG 3 0X010
Planning an; Developmentservlces P (; ei1TTi dC
9ullding and Code Regulotion Division -1-
2300 Orginl Avenue,Fort Pierce FL 34982
Phone: (77 462-1553 Fax;(772)462-157$ Commercial Residential
PERMIT A' PLICATION FOR: To*Select from dropbox, click arrow at the end of line
Address: ��
Legal Description:' -
9
Property Tax #; � •`j' _, Coo -Gk
Site Plan Name: _. Lot No;
Project Name - Block N.o.—
Setbacks F ntck: Right---� g Side: left Side:
1 •\O �� V =�"V_
�6 Y
id M W o e e orm un ert rspermit—c ec a appy; Yh77777_ „,tt, ;
VAC Gas Tank Dias Piping Shutters
. 11Windows/Doors:
Electric Plumbing �5prinklers 0 Generator Roof
Total Sq. Ft bf onstruction: 5 , Ft.of First Floor,-
Cost of Constr ction:$ UtilitiestSewer[]Septic Building Height:
Name �'�� H,�;;�,: w,,:•r•-i,M�,'
Name,
Address: Lwe- Company: r `
City
State: 'm Address:
Zip Code: G, Fax-,
Phone No, - CitYr ` • Stater
Zip.Code.. `S; Fax: '4(_0
E-Mail-
Phone No, r'
Fill in fee simp a Title Holder on next page(If different E-Maims
from the Own, r listed above) State or County License'W.(DJ"V_d1L
If value of const uction is$2500 or more,a RECORDED Notice of Commencement is required.
` 1y W.A.
DESIGNER/ ,: GIN ER fiiot Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City; State;_ City: State:__
Zip: I Phone: Zip: Phone:
FEE SIMPLE ITLE HOLDER: —Not Applicable BONDING COMPANY: —Not Applicable
Name: I Name:
Address: Address:
City: city:
Zip: Phone: zip: Phone:
I certify that nc work or installation has commenced prior to the issuance of a permit,
$t.Lucie Count makes no representation that is granting a permit will authorize theermit holder to build the subject structure
whlchisinconf ct with any applicable Home Owners Association rules,bylaws or ans covenants that may restrict or prohibit such
structure,Pleas consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideratiQr Jof the granting of this requested permit,i do hereby agree that I will,In all respects,perform the work
In accordance v,th the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following h ilding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory strucl ires,swimming drools,fences,walls,signs,screen rooms and accessory uses to another non-residential use:
WARNING T OWNER*Your failure to Record a Notice of Commencement may result in your paying twice for
imp ovemen s to your property.A Notice of Commence ent must be recorded and posted on the jobsite
bef a the fi t inspection, if you ntend to obtain finance ,consult wit lender or an a orney before .
corn, encin ding r Notice of Cpmmenc ent.
Signat re of s ee Sig a ure o Co tra ce se Hold
ti
STAT OF, RIDA STA EO F ARIDA
COU O - t COU OF
The forgoing in .. ment was acknowledged before me The forgoing ins r ent was ac owledged before me
this�day ' ,, 20 y this day of 20_1
� +Y
I
ame of rso 'acknowle ging (Name rson acknow a ging
nature of N ry Public-State of Florida) { atur Nota ublic-Ste•e of Florida) ;
Personally Known
iiiii ersonafly Kno n '�„�' .,Produce��l�����1�U�5ECr”' Type of kdentification P
Type of ldentifi 8t1 ! _ = Notary Public-S:FFF
e Of Florida
` My Com Ex res Jul 22,2017 6Qy Gor(aFse8�lreul�2,2017
commission N Comm 1 Commission No.
h #FF 038392 ''�,�occ� .•` Commission s 03$392
Revised 07/ 5/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS