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 34981
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR:
Address:�2cd QOl In l�f1)IYI�1 . ..1a�
Legal Description:��c ole. Z Onrl ES arq-ft Fim-y A&Ln L of it i n.-XIIAG
(01- Sr 11-21to Ova 81t>-238I)
Property Tax ID n:2421-LD02-fx»LI-QOO-LJ Lot No. _.
Site Plan Name: Block No. 2
Project Name: iMo+h WA CheN I buvI SOn
Setbacks Front Back: Right Side: Left Side:
DiSfall like Fair 1142 ymgg clooe-
Additional work o bepe rme under tis perm —check all 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:$1.I-lcb-00 Utilities: _Sewer _Septic Building Height:
Name I)MW34�yl TAAV-VSOr1 Name:_ ' v,-u na 1.L 4e,.v
Address:_ lA2k I R�Im
�� Company: h1M F.rtVernr;se of Pr ua,� db
City: For+Picyce State:EL Address: i108 7omahaok Di
Zip Code: '9RT2 Fax: Olpt City: Irvf;an )J-,bw— eecek State: FI
Phone No. L112A1Ck-PJ1.(el Zip Code: 32937 Fax: 3LI-777- 4Z34
E-Mail: 14 11, Phone No. 772 337-,V'170
Fill in fee simple Tide Holder on next page(if different E-Mail: (,u ss un raho>.mann _
from the Owner listed above) State or County License: 1
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
is
DESIGNE 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 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 ww:nants 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 recorcligg your Notice of Commencement.
S
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLOWA
COUNTYOF \lard COUNTYOF "C7TV(]YGI
The fo oing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisff day of IfCf Mrg"Y 201(—,*y this*2-1 dayof T1Yfn {'1"J- 20 )�by
IN f In w' ging) (Na ti s a wltdging)
k
I N Pu fate of Florida) ( gn r r pr ate of Florida)
e Kn R Produced Identification_ Pe n3Hy yy�^ OR Produced Identification
e ed Typep>ori r ncation Produced
CGmmis' 1�1-�(D�.�J omm sion No.25 19
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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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