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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 04.
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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
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Property Tax ID#: l Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESO]'PT'I0N'OF`WORK
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CONSTRUCTIbN .I N-FORIVIATION: -
Additional work to be nertormed under this- permit-check all that appy:
❑HVAC Gas Tank Gas Piping E]Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sq..Ft. of First Floor:
Cost of Construction:$ C
i �� Utilities: _Sewer Septic ,; Building Height:
,'G N'ER/LESSEE:: 1 CONTRACTOR,.
Name L ,� Name:
Address: Com pa ny:22� C
City: State Address: 0
Zip Code: Fax: City:il, i CVU-
state: l } r
Phone No.' Zip Code:j�S Fax. 2-
E-Mail: Phone N
Fill in fee simple Title Holder on next page(if different E-Mail: C-zyn
from the Owner listed above) State or County License: 1-043
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SU:PPLEIVIENTALCQNSTRUCTI,ON,LIf.NIA1N INFOR;MATION:. I'
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 a'ny 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 Amendmehts.
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 our Notice of Commencement.
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Signaof caner essee/ br tractor is Agent for Owner Signatu of Contractor/License Holder
STATE_r%EO STATE OF FLORIDA
COUNTY OF COUNTY OF
The�forygoing instru ent was acknowledged before me The forgoing instr ment was acknowledged before me
this C
3 day of 20 Eby thisQ day of 20 Lr)-by
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(Name of pe on acknowledging) (Name of rson acknowledging)
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(Si ure of Notary Public-State of Flo ida ) (Signature of Notary Public-State Qf Florida )
Personally Known OR Produced Identification Personally Known —" OR,hrodticed Identiflatlon
t LAS'i l a
Type of Identification Produced - 4Type of Identificat;on,Fr8atlti<ed
G1 ,,AHNA I11lloh N, ��i �� ;2 u � , 1,1M � `
Commission No. i - �` No(S`e'alNblic-State of Florida �ommission No ,'* �Y Comm.Ee SIF 17 249 1E
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my Comm.Expires Dec 20,201 l Commissl
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°;,;;°`•' Bonded through Naticnal Notary Assn.
commission#FF 177249
�'''�,°;;�••`• Bonded through a Iona
Revised 07/15/2014
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