HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZZIS 7 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: To Select from dropbox, click arrow at the end of line
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Address: aSi tv �C���o�ti' C ]�1e �, t`a 'r E� '�2 a�_q q_ C1
Legal Description: ' c)c cw -UeC_(In \,c ( -
Property Tax ID #:-�5 -� i ` d ��F-(Qo- `�„ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Windows/Doors
Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ q O o Utilities:'n Sewer 05eptic Building Height:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name 2
Name: bc%AL�_Oi STII-)M\O,)oG
Address: G 2
Company:
City-�:�'E N r\\ Qtl L- State:
Address:
State.E—L
Zip Code: 419 Fax:
Phone No. 3�]-7D i - S�S�
Zip Code:a��q 4 S Fax:
Phone "�� I - iQ(7
E -Mail:
Fill in fee simple Title Holder on next page { if different
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E -Mail:[ n�,; T i o,�rt�i,n aim n I�iA
State or County License:�;_�5
from the owner listed above),
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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 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 vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �' � � 'U C i COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this M day of a___, 20 11 by this day of Sgc1v L v": 20 L' by
(Name of person acknowledging ) (Name of person acknowledging )
4&dkl do&:�
(Sign ture of Notary Public- State of Florida )
Personally Known 1-/ OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/201
MAI !ti1
..
Personally Known \L OR Produced Identification
Type of Identification Produced
MICI 4E TROTTA Commission MICHELLE TRIJ$�
MY COMMISSION # GG0552531 MY COMMISSION # G0055253
REVIEWS
FRONT
ZONING
mm
PLANS
VEGETATION
SEA TURTLE
DESIGNER ENGINEER: _
Not Applicable
MORTGAGE COMPANY: —__
Not Applicable
Name:
REVIEW
Name:
Address:
REVIEW
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 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 vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �' � � 'U C i COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this M day of a___, 20 11 by this day of Sgc1v L v": 20 L' by
(Name of person acknowledging ) (Name of person acknowledging )
4&dkl do&:�
(Sign ture of Notary Public- State of Florida )
Personally Known 1-/ OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/201
MAI !ti1
..
Personally Known \L OR Produced Identification
Type of Identification Produced
MICI 4E TROTTA Commission MICHELLE TRIJ$�
MY COMMISSION # GG0552531 MY COMMISSION # G0055253
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS