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
1300 Virginia Avenue,Fort Pierre FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR:
Address:
Legal Description: 2pYl Ll b La 1:= Facnya�.s wLr5a Lo+i (Or ID1b-1�32j31o84-124�7
Property Tax ID p: Lot No.� _
Site Plan Name: Block No.951�)
Project Name: GCOW LDQl1AMt{ r
Setbacks Front Back: Right Side: Left Side:
mama like Fal like savant door 16X7
Additional work o be performed under this 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:$ I1gD•W Utilities: _Sewer _Septic Building Height:
Name rrairr J. mpss M*Icr Name: _ w
Address: iD-tAS pic`nry+P Cit'. Company: IRMfznir
tisc of
City: Rr•I-pierce State:EL— Address: HOD Tomal,aoy Di r
Zip Code: ;]Lml Fax:–W4 City: Ir a;� gaba., gecch State:Fl
Phone No. (7-214(07`1854 Zip Code: 30937 Fax: 341-777-4234
E-Mail: N/4 Phone No. 772 337-4470
Fill in fee simple Title Holder on next page(If different E-Mail: (.v. 55 a t <hw-on _
from the Owner listed above) State or County License: I1
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
MI -
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:
1 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 pians,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 recordinR vour Notice of Commencement.
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORLDA STATE OF FLORIDA
COUNTY OF \f k:d COUNTY OF �M\IaJTJ
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 11-by this 21L day of 20 1-1_by
03rif S
(Na er ec we g) {Na pe soih" a Iedgi g)
( + aur Nptary. JiI' ate of Florida) o irr,State of Florida}
R Son�lly 4�R Produced Identification Per ley OR Produced Identification
Ty fe�f ntiflcta�D duced T e Produced
� BROOKE S710 I =f
Commissl o. 244t 4ti mi ion No. 2441cea (Seal) c HuOFt Ali �4
MYCOMMISS10NtlF,2959 L+3 Otik s. 'r a
EXPIRES:June 22019
Banded Thu Notary Public ntlgrxsders ',y
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SLATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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