HomeMy WebLinkAboutBuilding Permit Application 4__ Fr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 IMPROVEMEW LOCATION:
Address: V �l
Legal Description:
Property Tax ID#: `-cC��- �UlXS- �( �n - ( st�' 2- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D.ETAILEO DESCRLPTION' OF WORK Q9
lV-
CONSTRUCTION INFORmATION
Additional work to e e orme under this permit-c ec a tat appy:
❑HVAC E]Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
UElectric ❑ Plumbing 11 Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction S Ft.of First Floor:
Cost of Construction:$ � O UtilitiesInSewer❑Septic Building Height:
OWNER LESSEE` CONTRACTOR:
Name _� Name:
Address: DC Company: I L
City: State: Address:
Zip Code: Fax: City: 7 State:
Phone No. _ - Z� Zip Code: G� Fax: _ — (-
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail: avnq
from the Owner listed above) State or County License:(�jUl7��P3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
sSUPPLEMENTAL`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 work or recording our Notice of Commencement.
s
Signatu wner essee/Contractor as Agent for Owner Sign atu o Contractor/License Holder
STATE OFFLORIDASTATE OF FLORIDA
COUNTY OF a1v.�,r.�� , COUNTY OF
The forgoing instru nt was acknowledged before me The forgoing instru ent was acknowledged before me
this day of 2011 by this day of 20 by
1
(Name of person acknowledging) (Name of person acknowledging)
igna ure of Notary Pu ic-S e of Florida) (§eature of Notary
\Public-Stat of Florida)
Personally Known "", OR Produced Identification Personally Known 1 OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
'• •° "- Notar gSHgHNA Ilya =•: _ Notary public_IiWAIGRAM
Revised 07/15/20 =�► *gyp My COm public_7 State o � +a, My Comm Expirestate o1 Florio
%oFo� `O`'•, m'Expire Florida '''OF f,°�;••' CoR►M s Dec 20 2
Ronde si #FF 'CU 018 through Na• 77 49
REVIEWS FRONT d rough a i§b PLANS VEGETATION otar M& GROVE
COUNTER REVIEW Sn. REVIEW REVIEW REVIEW VIEW
DATE
COMPLETE
INITIALS