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
Address: 11_�1
Legal Description:
fab du r^ /
Property Tax ID #:L -
Site Plan Name: n0 C h lic
Project Name: l6 h ro (
Setbacks Front Back:
in
PW.....I�
Right Side: Left Side:
Lot No.
Block No.
Total Sq. Ft of Construction: S. of First Floor: _
Cost of Construction: $ cv Utilities: Sewer Septic
Name I Y!C ty)
Address: �(_ fl>:s R lVo
i
City. lAfi' a �� _e�h State: (�
Zip Code: Fax:a'�)2'%
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name: V,
h
Company: AAon
Address: ( "" A
e Cl r
City: &tS}- (IteJ"O
Stater
Zip Code:7)4q,'5'Z
Fax: �?
Phone No. 4q 9) Ao
E -Mail: Gtllh C
C0Y_YIC'CeS- ,0f t
State or ounty License: C tie-
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIG
Name
Add re
City: _
Zip: _
NGINEER: _ Not Applicable
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
State
Not Applicable
MORTGAGE COMPANY:
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.
Not Applicable
State:
Not Applicable
St. 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, 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 recordiyg vour Notice of Commencement. /1
_ Signature,( O*ner/ Le!Kee/Agent
STAT"F`FLORIDA STd,,► VOF FLORIDA
COUNTY OF � LI -kc % � COUNTY OF S} L-Lkc I E
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this /I day of 20 Lby this I+ day of e � Y' 6"`� 20 1(el_ by
re.r C ro �srrv- n n -k f: re.+.,l C vc e-S.rvva..mn
(Name of person ac nowledging) (Name of person Ickn owl edging )
Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission No. FFDO
Revised 07/15/2014
KRISTINA L LOUD
jjF. V EXPIRES August 7, 2017
398-0153 FloridallotaryService.com
Personally Known ✓ OR Produced Identification
Type of Identification Produced
K
mission No.
398-0153
ISTINA L
My COMMISSION #F
EXPIRES August 7,
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