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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( Permit Number:
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F]itional
Building Permit Application
P=lanning and Development Services
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Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FC 3498.2
inflows/Doors
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
Sprinklers
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
PROPOSED IMPROVEMENT LOCATION:
Cost of Construction: $ iq 1 Utilities:
Address,
Building Height:
Legal Description:
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Name J C
Tax ID #: Iq �6-601 _ v _ q
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Lot No.—q--
Site
ite Plan Name: 9
Block No. �
Project Name: Or<!f e / (-G-c' 'y,. 4?-
City: rf Stale:
Setbacks Front t, Back: Right Side: Left Side:
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Zip Code: 2Z7 Fax:
DETAILED DESCRIPTION CSF . -ORK:
State:
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Co"UCTION,IN-FORT ATI0N:
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HVAC
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Gas Ta❑Gas
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Shutters
inflows/Doors
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11 Electric ❑ Plum bine ❑
Sprinklers
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E] Roof Roof pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ iq 1 Utilities:
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Building Height:
OINNER�LESSEE:
-
CONTRACTOR:
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Name J C
Name: a �,
Address: 1i/�'
Company: 0
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City: rf Stale:
Address: (
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Zip Code: 2Z7 Fax:
City: - c r
State:
Phone No. fWY) Q Z 7 - C ?Cj 7
Zip Code: — U f1 6 Fax:
E -Mail:
Phone U2 --
_62-60
Fill in fee simple Title Holder on next page { if different
E -Mail: R U.
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from the Owner listed above)
State or County License:
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
GINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applica
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
State:
,Not Applicable
I certify that no work or installation has Commenced prior to the issuance of a permit.
St. Lucie Count
yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 QWNER; 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 ou intend to obtain financing, consult with lender or an att ney before
carr2rner►cin ork or recd I our Notice of Commencement.
as Agents Owner
STAT OF FLORi A
CO TY OF C Y- I hJ
Ther roing instrument was acknowlecls dq before me
this day of 1_( .b
Y
oN S i•�S
(Name of person acknowledging)
41gnature�ofM2o�taryp �ric-ta4erida }
Personally Known OR Prod
Type of Identification Produced r•
Commission No.
Revised 07/15/2014
REVIEWS IFRONT
COUNTER
DATE
COMPLETE
INITIALS
NArr��
B���}VERLY M HALL
7 PSfblic - State of Florida
My Comm. Expires Jul 14, 2017
Bonded Through National Notary Assn.
STATE OF FLORIDAA
COUNTY OF
The forgoing instrument w s acknowledge before me
this day of .S{' 20 1� by
(Name of person acknowledging )
(Signature of Notary Pub State of �Florida)
Personally Known OR Pr ced I ratification
Type of Identification—Produce
Commission No. $e013
0E� ERLY M MALL
Notary Public State of Florida
Commission # FF 026091
Bonded Through National Notary Assn.
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