HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLIC B INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number: (vTC�I
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
Address:
Legal Description:
Property Tax ID #: `T - r ��� - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET
AIUD DESCRIPTION'OF WORK ."r
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CQNSTRUCTIrvON INFGRMATION
-AB-ditional work to be nertormed under t ispermit- check all
HVAC Gas Tank ❑Gas Piping
Electric ❑ Plumbing []Sprinklers
Total Sq. Ft of Construction: P
Cost of Construction: $ 1
appy: .
_ Shutters a Windows/Doors
Generator 1:1 Roof Roof pitch
S
:Ft. of First Floor: _
utilitiesSewer Septic
Building Height:
OWNER/LESS;EE21CONTRA&,,OR:°
Name C_
Name: -
Company: ([-
``
Address: t-�cJ'-C� -
City: Stater,
Zip Code:13L � Fax:
Phone No. l 1� -7,�1� - ����
E -Mail:
Address: i
City: 14o State: ' f
ZipCoclOLp i 2- r Fax: - `-�
Phone No. ` `�i - 3
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: , csY
State or County License: �l g
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
:SUP,PLEMENTAL CONST;R,UCTION LIEN LAIN INFORMATION"'
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 thepermit 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 your Notice of Commencement.
Owner/Lessee7Con`tractor as Agent for Owner
cense
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF1 COUNTY OF
The for oing instru n wase�noWledged efore me The f oing instrum nt was ack owledged before me
this jaday of20 by this ay of 20 �'t by
-kN-\ /7) C NI r-rv-1- 0 \(_)k_ V n 6 VY�-- M(___14T 1 �04_
(Name of person acknowledging) a (Name of person acknowledging)
(Signature -of -No ry Public- State of Florida) (Signature of Notar Public- State of Florida) ° \\
Personally,! no n n rsonally Known OR Produced Identification V
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Type of Iden���j o��r
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