HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO 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
O.POS°ED 11VIP-ROV MENT LOCA1'I:O.N::
Address: 0 wt ! A-
Legal Description: "k r 1
Property Tax ID #: "'I! L4 ), -7 LZ 000 O 1—S Lot No.
Site Plan Name: Block No.
Project Name: r C1. v' I(ff!c_=-h
Setbacks Front Back: Right Side: Left Side:
l q ,15 s e�>r, 6 .� r)1 f pl< vV ; 1 t Cmc-'n0C Gt.A+--
rtormed under this
_l Gas Tank
0 Plumbing
rmit- check all that apply:
is Piping _ Shutters
Sprinklers Generator
QWindows/Doors
0 Roof
Total Sq. Ft of Construction: j SCFtj of First Floor:
Cost of Construction: $ b `'I I �� Utilities: ! _1 Sewer []Septic Building Height:
Name r�-(A WCYI Qt)Y 56r)
Address AL tQ wtara�r_, r r+
City:
y 6 t. State:
Zip Zi Code: L C �ax:
Phone No. ��J°-i" qy,5- 11D or
E -Mail: li A --
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: �JeI I ' [.4 0(1 SfIDM
Company:iP1(I S v M /-H I/ corV1'410bI �
Addr s:_ Gl � �v' /l ,,cNei(2 v
City: C) M PbUQ (� I� 4 6 !_ State:
Zip Code:.3�blo'q Fax: 95 -51_&4Wq.
Phone No. �� -- " � o
E -Mail: Pao 1c1 3VQ/�, �,5j-ro m iq
State or County License: C' °�"5la C17
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
19
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Y.? '£ 2 . i. 7 [,....i!b:.+?'.�;:'::r ;,....•?.re's.: i:�f.:i�i;
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
State:
Not Applicable
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
commencing work or recording your Notice of Commencement.
i
s
_Signature of Own Lessee/Agent I Gre of Contractor/License Holder
it
STATE OF FLK
IDA
COUNTY O
The fpqoing instr &as a knowledged before me
this day of 201I/ by
it",Zg
(Name of person
(Signature of Na
STATE OF FLOJ, A
COUNTY OF �r
The forging instrumentwas cknowledged before me
this% 'day ofd<.;®'�,- _by
TAMMY ZIESAK
Notary Public - State of Florid
r CSI irnc to 20
bwl (Name of person acknowledggiCommis ZIESAK sion
4P FF 137629
Notary Public - Sta of Florida
My Comm. Ex_autet Aug 25, 2018
FF 137629
Ic= 5t ` e`bf lot iaa�i�"`` `� ' '� (Signature of Public- State of Florida )
4
Personally Knofurf OR Produced'tification Personally Known OR Produced Identification
Type of Identification Produced / ,/ ___1 Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
Commission No. (Seal)
SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW