HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (A4.q
Date: Permit Number: T7 . 1
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 i
PERMIT APPLICATION FOR: Shutter
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9T lG1CATlON
Address: dlzo"
Legal Description: &2%74Z_..
Property Tax ID#: _5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED 1b FMORK:
,
Id
CONSTRUCTION-INFOCY
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Additional work tobe ertormed unde this permit—check all that apply:
UHVAC Gas Tank FiGas Piping _Shutters Windows/Doors
F]Ele' Q Plumbing OSprinklers
Electric Plu Generator FIRoof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities: lewer R Septic Building.",Height:
0
NT
ERA
Name Name:
Addresms: 5� _05-41�_ , f4��124—f Company:
City: State: Address.
Zip Code: Fax:?fly•YZzl= �0 3 e City: State:
Phone No. "/,R Zip Code: Fax:
E-Mail:/7&rAg J.&AofPrk r-&r Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
;SUPPLEMENTAL CONSTRUCTION LEEN LAW IUFQRMATIOgqN
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:
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 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 our Notice of Commencement.
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Signatu of Owner/Les Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFI COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this Lo day of I 20 IZby this_day'of 20 _by
(Name of person acknowledging) (Name of person acknowledging)
igna ure of Notary Public-StRe of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification' Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
j'k3o---12k -Lk s - 6 t 0 ,( 1 . 11
Commission No. (Seal) Commission No. (Seal)
HNAINGRAM
Notary Public-State of Flon
Revised 07/1 `
M Comm.Expires Dec 20,2018
rnmmission#FF 177249
@,�, ,,,1'n•,o,,h N,Tonal Notary sbiLb
REVIEWS 'FRONT" LO,,;NING """'SWRVISOR3 PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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