HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE I FO( MUSt
BE
COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �v �/ 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 Zine
PRO' I?'OSED`:IMPROVEMENT LOCATION'.
Address:
Legal Description:
Property Tax ID #: S4 0` 1 �\ 060_ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.:OF."WORK.
a.
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.c0 „�.
NSTRUCTIONINFORMP►1 ION.
Additional work to be ne orme under this permit— check a appy:
HVAC L_J Gas Tank []Gas Piping _Shutters a Windows/Doors
171
LLJ Electric ❑ Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ -� Utilities"nSewer OSeptic
Building Height:
01NN,ER/LESSEE
CONTRACTOR:..
Name
Name:
Address:
Company:
City: I
State:
Address: L> Vlck
Zip Code: Fax:
City: S,,ta((ter
Phone No. — —
r^ CD
Q
Zip Code: Z Fax
2 %6,2J 2
E -Mail:
Phone No. —
Fill in fee simple Title Holder on next page ( if different
E -Mail: -
from the Owner listed above)
y
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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
commencin>; work or recording; your Notice of Commencement.
as Agent for Owner
v
STATE OF FLORIDAC\ % E n �-.i STATE COUNTY OFORIDA
COUNTY OF � L,VC �
Th oin instrumprit was acknowled before me The for oing instru en,t was 4ctpowleclged before me
thiay of CJ 20 y this y of 20 T�4
(Name of person acknowledging) (Na of person acknowledginX )
(Signature of Notar ublic- State of Florida) tart' ublic- State of Florida )
Personally Know r c I ntification iy-K"e _ OR Produced Identification.
.> Type of Identific mns
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Revised 07/15/2014" -
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