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:
Legal Description:
Property Tax ID C19 — — Lot No. L
Site Plan Name: ��11 nn Block No. In
Project Name: i4 elJ
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK; �J
P)4
CONSTRUCTION INFORMATION:
;ANdd', na wor to a er orme un er t is permit - c ec a appy:
HVAC Gas Tank OGas Piping _ Shutters a Windows/Doors
❑ Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ Q �) � 6 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 6,J
Name:
Company:
ac
Addre %-�� /
City: 4- State:
Address: Y916 MA
q1 5 �
City:
Seta-t-e:JG.
Zip Code: 3 d Fax:
Phone No. 7-0��v.� - -���
Zip Code:
Phone No. �- �
�,OFax: J` -.507-�/
- 60
99
E -Mail:
Fill in fee simple Title Holder on next page ( if different
E -Mail:
0)
from the Owner listed above)
State or County License:
If value of construction is 52500 or more, a RECURRED Notice of commencement is requires.
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 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
CUMUlenC11119 WUIK U1 ICCUFU1
Signature of Owner
STATE OF FLORIDA
COUNTY OF
UUI IVULIL.0 UI \.UI I If I M1 ILCI 11 MIL.
as Agent for Owner Signature of Contractor
The forgoing instru yit wa�knowledged efore me
this day of 20 "y
(Name of erson acknowle g
i);nature of fN(ot^ Puiblic'- State of Florida )
Personally Known Rpt ycedp1i196D`Cd�i$ NBERU
Type of Identificati n Pr rX t,s Commission # FF 935427
z Expires November 11, 2019
Commission No. Imy Fin lnsunna 800.3857019
Revised 07/15/2014
STATE OF FLORIDA'
COUNTY OF
The forgoing in t ument-was acknowledged before me
this day of _t L" i c 20 L_2 by
(Name 9f pj?fson acknowledging,)---)
Kiinkture of No ublic" 3f—ate of Florida )
Personally Known
Type of Identificati �d� H R ENB
Commission No. ,a�` Expires NoveTtig i1,, 2019
OmidadThmTy Foul Gum 8003857019
0
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