HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: — 0 —.Z!7 Permit Number:
5'-} of J
s _
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34382
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: % �`+° � tr i` - r 1 �� ? 4)
r 91
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK: re I
CONSTRUCTION INFORMATION:
jj��itiona wor to e er orme under this permit- c ec a apply:
[1HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers M Generator Roof Hoof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: n
Utilities: Sewer LJ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_ ff ar i.�
Name: I cts 0,-,
Address:
Company: _516ed, feld<
Clo in r'vsq
City: fc.liG State: _
Zip Code: 5!Vd Fax:
Phone No.
Address: f C9�� �k
l lX� i,, 1i
City: "&k 1 car
Zip Code: 3 Y rt ? 7
Phone No. 17Z.2 -7
Stater(_
Fax: ?7-2 2 5
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail:
State or County License:
/ S�
If value of construction is 52500 or more, a RKURML) Notice or Lommencemenr is requires.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
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
commencing work or recording your Notice of Commencement.
as Agent for Owner
STATE OF FLORID
COUNTY OF �,I j
The for instr ment was acknowledgi>efore me
this day of _� 20 by
(Nenw.of person acknowledging }
Notary Public- ktate of Florida )
Personally Known
Type of Identifica,
Commission No.
Revised 07/1512.014
S
Si e of ContfadforfUcense Holder
v'
STATE OF FLORI A
COUNTY OF - LL.. Cl
The forgoing instr,uknent was acknowledged before me
this day of 20 ` by
(Na of person acknowledging }
(' nat e o Notary Public State of Florida }
Personally Known " '� P odu Identification
Type of Identification Pro ce,
Notary Public - State of Florida 1i I
_ Commis(SOB4 GG p62220 Commission No.
My Comm. Expires Mar 16. 2021
Bowedthrouch Nsrhnnal Nmary 6- t I
No P blic - State of Florida
i�sion # GG 062220
My Comm. Expires Mar 18, 2021
o ary ASStj
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