HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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: U\(Av_,)-
Legal Description: .A, [),(
- � LLa_e:t>
Property Tax ID #: V -�> 42 ar z_ S _ Lot No._J�
Site Plan Name: r _.��. _ Block No.
Project Name: � U_"ra L i
Setbacks Front,- - Back: _ _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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I.CONSTRUCTION INFORMATION:
Additiqpai work to be pertormea un er this permit -- check all appy:
HVAC Gas Tank OGas Piping Shutters ❑ Windows/Doors
1-1 Electric ❑ Plumbing Sprinklers Generator E Roof Roof pitch
Total Sq. Ft of Construction _ S� of First Floor:
CS(Ds: Sewer l �� Septic Building Height:
Cost of Construction: $_� Utilitie
OWNER/LESSEE:
CONTRACTOR:
Name c_
Name: ,tSY
Address:
Company: 1fr•, ti
City: State:
Ad(�,ress:
City:�A/VQ State
Zip Code:4yn - Fax:
Phone Nox--Qg a: Le_
Zip Code:
E-Mail: _
Phone NO--S Q' Q J f +
E-Mail: 2i1
Fill in fee simple Title Holder on next page ( if different
State or County License:
from the Owner listed above)
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: e_____
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
commencing work or recording your Notice of Commencement.
_ Signature of Owner/ L e Rent
STATE OF FLORI A
COUNTY OF
The forgoing instrument was acknowledged before me
thisday ofWPI { 20\aby
(Name of person acknowledging )
i
(Sign Ob
re Notary Publi - State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission
Revised 07/15/2014
s
Signature of Contractor/Livens older
STATE OF FLO A
COUNTY OF
The for oing instrument was acknowledged before me
this day of� 201 by
(Name of person acknowledging)
e cam ---7
(Signat r of tary Public- Slate of Florida )
Personally Known u_, -"'0R Produced Identification
Type of Identification Produced
rt JOYCEMICHAUD Co fission No b$3m2�
My COMMISSION # FF 4�6
EXPIRES: April, 25, 2D 0
JOYCEMICHAU
ZONING
SUPERVISOR
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MY COMMISSION # FF
006
t EXPIRES: April 25,
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VEGETATION
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REVIEW
DATE
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INITIALS