HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
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 41
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
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Legal Description: E'u% _2 1f d'"'
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Property Tax ID #:1 y -X, r Ci 00 —0C�d
Site Plan Name: i
Project Name: —'
Setbacks Front Back: Right Side: Left Side:
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11HVAC
11 Electric
Lot No.
Block No._
e ertormea unser tnis permit – cnecic aii apply:
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Gas Tank ❑Gas Piping _ Shutters Windows/Doors
0 Plumbing 1:1Sprinklers � Generator E]Roof Roof pitch
Total Sq. Ft of Construction:
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Cost of Construction: $t�®''
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S Ft. of First Floor:
Utilities: []Sewer[]Septic Building Height:
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City: A- � :kp— F-7— State:
Zip Code !q !? Fax: —~
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: JKJ
Address:
City: State:
Zip Code: Fax:
Phone No.
E -Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ,
DESIGNER/ENGINEER: ��KTot Applicable
Name:
Addre!
City: _
Zip:
Phone:
State
FEE SIMPLE TITLE HOLDER: Jot Applicable
Name:
Address: ,
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address: I
City: State:
Zip: Phone:
BONDING COMPANY: _VNot Applicable
Name: I
Address:
City: I
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 oar an attorney before
commencing work or recording your Notice of Commencement.
M, Kwoo czc
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA L4ag,
COUNTY OF
The fing instrua�t was a knowledge efore me
thisday of 6J l 1JJ 20 by
�1/Ilieaf furl ,r�
(Name of person acknowledging)
(Signaturelaof Notary Public- State of Florida )
Personally Known OR Pro uc I enti,f4cation
Type of Identification Produced (_ LE
Commission No. L—r 'Z`V /15 ,, ��? MARCIA
Notary Public -
Revised 07/15/2014
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Signature of Contractor/License Holder
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STATE OF FLORIDA
COUNTY OF
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The forgoing instrument was acknowledged before me
this day of
20 _ by
I
(Name of person acknowledging )
i
f
(Signature of Notary Public- State of Florida )
I
Personally Known OR Produced Identification
Type of Identification Produced
of Florida
My Comm. Expires. Mar 30,2020
Bonded through National Notary Assn.
No. i (Seal)
REVIEWS
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ZONING
SUPERVISOR
PLANS
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
COMPLETE
INITIALS
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