HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1-ruz
a
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 OPOSED IMPROVEMENT LOCATION: _..
Address:
Legal Description:-Teop 1 CA L_ Alive-.) C-`C C Lv' f 2>�
Property Tax ID#: J� L Lot No.
Site Plan Name: Block No.
Project Name: Pi oXD cs_. aLa,rl'►
J
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:-,;'
CONSTRUCTION INFORMATION:
Additionalwor to r orme un eis permit-c ec a ppy:
❑HVAC GasTank ❑Gas Piping Shutters ❑Windows/Doors
—
❑Electric ❑ Plumbing []Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ _ Utilities:-Sewer❑Septic Building Height:
OWNER A , rEf: CONTRACTOR:
Name ��� ��,►� cm 4 J✓1 b b Name:
Address: `Y/l7 Sv►V �(;2 Company:
City: N�C�-� State._ Address:
Zip Code: `lbf Fax: City: State:
Phone No. 2--- Zip Code: Fax:
E-Mail: 016 Q D E� �''IJ O' Chief Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: � Not App MORTGAGE GE COMPANY. Y 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
comme in wor or recording our Notice-of-f Commencement.
s
Si ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF ��_,r_�u . COUNTY OF ��, �S
The for oing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this day of j 20 I-Uby this day ofy��`�� 20 by
(Name of person acknowledging} �� (Name of person acknowledging)
Cyr,.
(Signature of Notary Public-Sta of Florida} (Signature of Notary Public-State of ftricla}
Personally Known OR Produced Identification Personally Known OR Produced Identification
T e o en fication Produced Type of Identification Produced
T Q0IT Ql
Commission No. {Seal} Commission No. - {Seal
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LAS
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LAS_.:AHt,'A 1i GRAM zu i * ' t:4y Comm. Ex a e of Florida
Revised 07/15/2014 ;r°,�` Notary Put lic-Stato of Irlori�a '•;;F ��` Co
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COUNTER R REttl REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS