HomeMy WebLinkAboutBUILDING PERMIT APPLICATION �l
ALL APPLIC BLE INFb/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I l Permit Number:
11' Nit-
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
:,P.ROPOSED,IMPROVE'ME*IVT LOATIO;N ,,
Address: ( o
Legal Description:
Property Tax ID#: ��t-7(���c, OC�C>c(- ccJ- 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: \
DETAILED DESCRIPTION.'OF WORK
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CONSTR'IJCTION IN:EORIVIATIO.N
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Additionalwork toa performed under this permit-check a tat apply:
❑HVAC F] Gas Tank Gas g Shutters Windows/
Doors
in - _ Doors
Piping ❑Windows
Electric ❑ Plumbing Sprinklers Generator Roof Roof,pitch -
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _4 Utilities: Sewer O Septic Building Height:
F
OWN, ..%LESS',EE CONTRACTOR
Name V G Name: 'n
Address: /� -i�fV LDS Company:
City: Il X State: Address: C) LL'�
Zip Code: y Fax:
City: Q State:
Phone No. �7,- �- ky l� Zip Code: - L�Z Fax-LIWI -q(495
E-Mail: Phone No_ 2- L-{ _ 93 I
Fill in fee simple Title Holder on next page(if different E-Mail: 4 _
from the Owner listed above) State or County,icensea�(�C`l�( 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S.UPP'LEMENTALCONSTRUCTION LIEN LAW:INFORMATION.°
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:
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 our Notice of Commencement.
s
Sign to of Owner/Lessee ontractor as Agent for Owner Signat ontractor/License o er
STATE OF FLORIDA! STATE�OFf
LORIDA
COUNTY OF ,�) �� C�,�� COUNTY OF
The forgoing instru ent as acknowledge��f re me The rgoing instr nt was nacknowledged before me
this Z6ay of 20 yy this,. ay of X11 20 y
(Name of person acknowledging) (Name of person acknowledging)
(a PLud & 0 a6l�4a 6,— #��
(Signature of Notary P blit-State of Florida ) (Signature of NotAJy Public-State of Florida)
t
rsona Kms• OA�{�dd�.�EMFaentific�tion own wn R Produced Identification
9 i 'rEP r�gdblic-State of Florida � ed
E'• • Commission 730 �?°�P °��= ANGELA MHUFF
My Comm.Expires May t^ ' Notary Public_ of Florida
Commis oiY% Fro,. (�yY C•ri� bJsra� eal)
National Notary r.,� *°�; mission#FF
F�o?;�'� MY Comm.Expire 234730
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a y J roup Nationa,No,
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Revised 07/15/2014 �.—.._. ::
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