HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -
Date: Permit Number: O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 I
Phone:(772)462-1553 Fax: (772)462-1578 Commercial >C Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of linel��inC� 5
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Address: qty s . DceoLn D•riyc unit 301 jemcl n Befto hl, F1. 349 -7
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Legal Description: f`Mpr'P_ss
Property Tax ID#: L4-513D. - (gQ0- COOS - C I Lot No.
Site Plan Name: --T P _F_ rnQreS cwdc) I Block No.
Project Name: e_ --Pl (r l�r r f ?
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Setbacks Front Back: Right Side: Left Side:
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itiona wor to je a orme �un er t- is permit-c ec a app y:� i "'
HVAC �Gas Tank ❑Gas Piping _Shutters I Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
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Cost of Construction:$ '7 r(` utilities: _Sewer-Septic BuildingiHeight:
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Name -i M
Address:
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City: jePnsenC-.h State: EL
Zip Code: 3cj� Fax: City: esti State:
Phone No. Zip Code: agcn-1 Fax: "7-7Ok -0140
E-Mail: Phone No. -17,a n
Fill in fee simple Title Holder on next page(if different E-Mail: 'Mi"I's Mos-y, ,��'M02 n�) .cofn
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _,Not Applicable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone: Zip: Ph i ne:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: I
City: City:
Zip: Phone: Zip. Phine:
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 permi '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. j
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 mayl result in your pI aying 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 len ey before
commencin work or recording our Notice of Commenceme I
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caner/Lessee/Contractor as Agent for Owner Signat a of Contractor/Li a Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF YY1 ar�i n COUNTY OF laa-rwo
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 /7 by this day of 201 17 by
6-111ol lwmole,
(Name o person acknowledging) (Name of person acknowledging) I
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7-L)I:
(Signature of Nota Public-State of Florida) (Signature c6qotary Pu
blicate of Florida)
MUMd Identification V/ Personally Known
IdentificType of Identificatio Prctd
Notary Public-Stateof �,,.••� °e
` mission FF 929255 Notary Public-State'of Florida
r�iong981 (Seal) Commission No. _•' ' •: Comr"ida M FF`9-29255 .
,.F. °•• M tfaoughNadsOct onalNotaryAssn' "�9F °P� My Comm.Expires Oct 20,2019
i�1111 I''�'•i,,OF F�,�
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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
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INITIALS
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