HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �i Permit Number:
_ u,
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 IMPROVEMENT LOCATION:
Address: ( ,.�-
Legal escription: (i
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Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
Back: ` Right Side: Left Side:
Lot No,
Block No.
DETAILED DESCRIPTION OF WORK: 1
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CONSTRUCTION INFORMATION:
Additiogatwork-to-5-e-D-e-rFormed under this permit - check all appy:
�_` HVAC ! Gas Tank []Gas Piping Shutters Windows/Doors
LJ Electric 0 Plumbing Sprinklers EnGenerator a Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ M� Utilities:'n Sewer 17 Septic Building Height:-
-OWNER/LESSEE: CONTRACTOR:
Name Name: Y _
Addre s: Company:
City: State: Addr. ss19 +�
Zip Code: Fax: City: f` State
Phone No. + Zip Code:Fax-^c�,: �t't Cl
E -Mail: Phone N
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Fill in fee simple Title Holder on next page if different ! E-Mail:from the Owner listed above) State ory License: t_ {� f
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: T Not Applicable
Name:
Address:
Address:
City; State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 vour Notice of Commencement.
s
_ Signature of Owner/ L e Age t Signature of Contractor/,U ens older
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STATE OF FLORI A STATE OF FLO A
COUNTY OF �`— COUNTY OF
The f oing instru ent as acknowledge efore me
this _H day of f 20 Llby
�Q �
(Name of person acknowledging )
(Signa re olf Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. 10 (Seal)
Revised 07/15/2014
REVIEWS FRONT
COUNTER
DATE
COMPLETE
INITIALS
JDYOE 1AIGHA00
EXPIRES: April 25, 20111
Bonded'rkry Net" P"Ui; VhWoM140"
The N oing insent was acknowledged before me
tru
this day of 20 by
(Name of person acknowledging)
(SignatuN of Wtary Public�Stat�of Florida )
Personally Known L� OR Produced Identification
Type of Identification Produced
Commission No\ lU (Seal)
ZONINGI SUPERVISOR PLANS
REVIEW REVIEW REVIEW
MY COMMISSION # FF 003005
EXPIRES: Apiil 25, 2010
Bonded Thru Notaiy Public Undervwnlars
VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW