HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO JUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED MDate: Permit Number: 1I '
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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
PROPOSE2D IMPROVEMENT LQCAT�I:O,N� 1
Address: 3,J`J`J v 1. 1 A �..�� 3CIT–)
Legal Description:
Property Tax ID#: �'�(Z)57 – UO) " Oa U1 LJ –CCC-1Q Lot No. o?Q_
Site Plan Name: ! Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION Of WORK ,
CONSTRUCTION INFORMATION
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Additional work to be pertormed under this permit-check,a appy:
HVAC Gas Tank Gas Piping Shutters r Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
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Cost of Construction:$ 0 .� Utilities:Sewer El Septic Building Height:
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OVV:N ER/LESSE"E CONTRACTOR:
Name Name:
Address: Company:
City: State: Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: 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.
SUPPLEMENTAL CONSTRUCT" ON 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 a'nother: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. 11 you intend to obtain financing, consult with,lender o, an attorney before
commencin work or recording your Notice of Commencement. f
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ign t ner Lessee o r ora Ag nt f r Owner c is s Ho d
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��t COUNTY OF
The forgoing in ment w s acknowledged before me The forgoing instr ent knowledged before me
this a day o 20 ]Qby this_1L day of ; 20 by
( "me of person acknowledging) (Name of person acknowledging)
n
ign .tu( of Notary Public-St a of Florida) ignature of Notary'Public-StafAof Florida)
Pe sonally Known OR Produced Identification Personally Known OR Produced Identification
Tune of Identification Produc of Identification Produced
LASHAHNAINGRAM
Commission No. ;�° � ebary Public-State of FI r� mission No. ,.•�Pa��CB•,, LAS�A�i�I�INGRAM
*.•:My Comm.Expires Dec 20,20 8 ;r. Notary P rc tate of Florid; �..
Commission#FF 1772 9 =•« in t
« My Comm.Expires Dec 20,20',
one roug v 1R24..
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Bonded through National Notary Assr
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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