HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO
-�MUST
IBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /•/�(/ 1�. Permit Number: / 0703 "0�/ L
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Building Permit Application MAR 2 0 2017
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
PR'OPOSED`IMiPROUEME,NT LbCATI0`N
Address:
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF WORK
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CONSTRUCTION INFORMATION
Additional work toe e orme under this permit-c ec a appy:
❑HVAC Ei Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
10 Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 1 z _) Utilities: Sewer❑Septic Building Height:
01NNER/LESSEE 4z ^ ...' y CONTRACTOR
NameName:
Address:_5_ S �� C bv-- Company:
City: �� `C �Q State:`i Address: W
p .,_�Ag, Fax: City: ycc Stater.
Zi Code• �2 II
Phone No ;���- I S Zip Coder�`ic� Fax: l l� -4-pt-u(r2�
E-Mail: Phone No.--R7
Fill in fee simple Title Holder on next page(if different E-Mail: 9
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from the Owner listed above) State or County License: Ecl - Y__3 1��3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I $UPP'LEMEN"TA4L'co'NSTRU'-CTiON LIENIAW INFO".RMATION:
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. ,
ills
Signat a of Owner/Lessee/Contracto s Agent for Ow ign t of Contractor/License Holder
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STATE OF FLORIDA s• TATE OF FLORI -moo
COUNTY OF m OUNTY OF 2 �s m
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The forgoing instrument was acknowledged before me z m he forgoing inst ument was acknowledged befor d z
this�ay of 10 )e 20 13by ncn his day of 20 l� by �T_
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IKIe of person acknoQ7"M RA
wledging) a;N j a e of person acknowledging)
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Signature of Not 17
Public-State of Florida V (Signature of Nota ublic-State of Florida)
Personally Known / OR Produced Identification Personally Known / OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS