HomeMy WebLinkAboutBuilding Permit Application�_ I
`'All A01PLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. , 1p-InPermit 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:
Address: >(!%/ 'Je
Legal Description:
Property Tax ID #: 06,9 -s
Site Plan Name:
Project Name:
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Setbacks Front. Back: -- Right Side: _� Left Side: D
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Haamonai worK to oe perrormea unaer tnis permit – cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
lectric _ Plumbing _ Sprinklers = Generator
Total Sq. Ft of Construction::
Cost of Construction: $ !�
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Lot No.
Block No.
_ Windows/Doors
Roof Pitch
Building Height:
Name el' -A J Name:
Address: Atl// Company:
City: ' ,,���;;E/tee State: GG Address:
Zip Code: JT/ 5,"7 Fax: City: State:
Phone No. 9;V S90� 7 Zip Code: Fax:
E -Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E -Mail
from the Owner listed above) State or Cou License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY
Name:
Address:
City:
Zip: Phone
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 covenant's 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 revielw: 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
commpicing work W recording,yogr Notice of Commencement.
Sigri'6rure of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA��
COUNTY OF
The fiqfping inst ument a 9 knowledged before me
this day of 201Py
Le,,'_� (S
(Name of person acknowledging) n n
/11
(Signature of gotary Public -State of Florida )
Personally Kqo!yn OR Produced Identification
Type of IdeniifRi�
Produced �� b' AM4 UFF
ary Public - State of Florida
CommissionOommission # FSeaib0
xpires May 27, 2019
r Bon1d throu0t, iVational Notary e��„
Signature of Contractor/Lici nse Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20_ by
I
(Name of person acknowledging )
ature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
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Commission No. (Seal)
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Rev. 7/2014
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Rev. 7/2014