HomeMy WebLinkAbouttheiling permit appALL APPLICABLE IN(O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o� i Permit Number:
1 _
2 V
VV `° 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: 1
Address:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: L4L-t10_
Setbacks Front
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
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CONSTRUCTION INFORMATION:
CONTRACTOR:
Name rl
Additprial work to ene orme under this permit - c ec
Gas Tank ❑Gas Piping
a apply:
In Shutters
D Windows/doors
IZ7THVAC l_J
City:
Zip Code:
Phone No.
1 State -
Fax:
3 1
11 Electric ❑ Plumbing
Sprinklers
F� Generator
❑ Roof Roof pitch
Total Sq. Ft of Construct'io{n:
S Ft. of First Floor:
Cost of Construction: $ �, . au
Utilities:U Sewer ❑ Septic
Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name rl
Name:
Address: S k U r(
City: Stater
Zip Coder Faux:
Phone No�a-a��'���5 l - ----
Company:
Addre s:
City:
Zip Code:
Phone No.
1 State -
Fax:
3 1
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Ir�
E -Mail: zazkC_S
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:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
cornmencinz work or recordin our Notice of Commencement.
Revised 07/1512014
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51daTure of Contractor/License Holder
ign ure of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
�� L,V
STATE OF FLORID t
COUNTY OF • C.1
COUNTY OF •
The forgoing instrument was acknowledged before me
this day of 20 by
The forgoing instrument was acknowledged before me
this day of 20 ft by
{Name of person ack wledg;;; •., AMY K. PEAR
REVIEW
f person acknowledgi
AMY K. PEARSON
?tR' .. commission # FF 235217
Expires May 27, 2019
DATE
F.
=k; .- Commission # Fl 235217
�- a Expires May 27, 2019
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ign re o otary Public- State of Florida)
tur o Notaryy Public- State of Florida
'
Person nown OR Produced Identification
Personally nownl` OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. (Seal)
Commission No. (Seal)
i
I
Revised 07/1512014
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