HomeMy WebLinkAboutBuilding Permit Application All 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:
Address:
Legal Description: \4r
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Property Tax ID#: ,��[ -(�{�-(ri(�-{ Lot No.
Site Plan Name: Block No.�l =-
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed under this permit We, I that appy:
_Mechanical —Gas Tank _Gas Piping _Shutters ✓Windows/Doors
Electric —Plumbing Sprinklers _Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$�t�'X�.00 Utilities: _Sewer _Septic Building Height:
NameTx4{(1 c5 Name:
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Address: c� C][}{T r(t IYcP.1)V-. Company: Mm E fisc a4
City: Nf'elYih State:Ll Address: 005 Tornakgok 'Di
Zip Code: 1;�)LA(-ln(o Fax: NlA City: Indi-A }Aeby ee.CA- State:_F1
I Phone No. �q20� `��(,-LLOf'� Zip Code: 32937 Fax: 341-777• qZ3q
I E-Mail f1l1A Phone No. 772.X37-4( 0
Fill in fee simple Title Holder on next page(if different E-Mail: t&4-__5ShaannAPahoy awn
from the Owner listed above) State or County License: +�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
�SUPPLESAENTALCONSTRUCTION UENLAW-INFORMATIOAI;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:_ City: State:_
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: 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 Counttyy 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 resuft 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
commencins work or recording our Notice of Commencement. �J{�'[,/�
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_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLQQRIDA ,�,. ��II
COUNTY OF��(QYCA COUNTYOF7{"A'_\IL YQ
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of MI . 20 Uo_by this day of OUGUI l' 20 ILO_by
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Ii State of Florida) ( a f ic- ate of Florida 1
son no OR Produced Identification_ Pe o y n n R Produced Identification
Ty ofl oduced pe f ti uced
Commission o. Z. 4 Ali I) BROplgaLeEn. om •"• 4
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EXPIRES'Joe 25.9010 '
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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