HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r� - / 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
PROPOSED IMPROVEMENT LOCATION:
Address: 1'7
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
S •% J."1 J%fC C-,L_�• 7 • /-4G
CONSTRUCTION INFORMATION:
CONTRACTOR:
Name jam-(
Additional work to be nerformed under tis permit - check
E]Gas
all
apply:
a
Address:
City: t-' `c�� State: -I- L
HVAC
LI
Gas Tank
Piping
State: r<=
_
Shutters
Windows/Doors
_
Electric Plumbing
Sprinklers
a Generator
a Roof Roof pitch
Total Sq. Ft of Construction:
from the Owner listed above)
S Ft. of First Floor:
Cost of Construction: $ -� `i cc;,
Utilities:
Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name jam-(
Name: r C
Company: mat2�.i�c�—
:�^ ` ��.-�/► �—
Address:
City: t-' `c�� State: -I- L
Address: /—/ S S-
Zip Code: Fax:
City: J C--
State: r<=
Phone No. (o I Z s C/c(
Zip Code: 3--15 j--3 Fax: -7-y--
2 2 `/ ---5-0 (.
E -Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E -Mail: Cor,
from the Owner listed above)
State or County License:
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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[Aork or recording your Notice of Commencement.
i
re of Owner.
STATE OF FLORIDA
COUNTY OF
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The for ping instrument was acknowledged before me I The forgoing instrument was acknowledged before me
this day of �cx �7 20 %7by this % 3 day of -!=a, 20 i -7 by
Acam.,: k i r ID
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known '---'OR Produced Identification Personally Known L ---'OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. 5,)S_;LP (Seal) Commission No.r /9oZ1�►� (Seal)
Heabw Headw Tio
NOT NOTARY PUBLIC
STATE OF FLORIDA STATE OF FLORIDA
Revised 07/15/2014 Coma►# FF192528 Caw* FF1925n
welsiv Exniruc a ion, , ,. Exelres 1/25/2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS