HomeMy WebLinkAboutBuilding Permit Applicationi ALL APPLICAB E INJO 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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end �f
line
PROPQSEO 11111PROVEMENT
Address:
C
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
moi"
Back: Right Side:
Left Side:
Lot No.
Block No.
P�C`kj� '+ S
Aaoitional worK to pje nertormed under this permit —check all apply:
HVAC L—J Gas Tank E]Gas Piping _ Shutters [IV'
Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ Utilities:nSewer Septic Buillding Height:
NameJ� e: YV(�trC� ;ll I- ")y C
Address: °`` 9� e- Company
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City: n Q1 1 State: AI Address:
Zip Code: Fax: - City: v State:�
�-
Phone No. —]'7� �0 — 1611— Zip Code:r 171
Fax:
E -Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E -Mail: r12
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: 4 1 f 4
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone: I
d
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
REVIEW
City:
Zip: Phone:
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 thepermit 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 restriction's which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, pbrform 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: roo 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 he firset�ispection. If you intend to obtain financing, consult with lender or an attorney before
comm cinRy(y6rk or record ir�vour,Notice of CommencemQnt. If I /
Sign re/of Winner/ressee/Contrac r w Agent for Owner Sig)rre of Corffractor/License/Molder
S ATE OF FLORIDA r % �C�' STA/TE OF FLORIDA
COUNTY OF c(1 4&L(�7COUNTY OF
The f r oing instrument knowledge efore me The for oing instrume as acknowledged before me
this � day of 20 by this day of� 20 by
Lln(A. )A - OL
(Name of erson ac nowledging) (Name of erson acknowledging )'
ture of Notary Public- State of Florida) (Signat ora Pub ic- State of Florida )
Personally Known, OR Produced Identification Personally Known OR Produced Identification
Type of (dent fi.ct"on Produced Type of Identific yp
�f `
ti oI , y Jane -{les
Commission fit, Janet` al s Commission No. a tar Publi `tea}e oft=lorida
NoteryPublic` aofFlotids N < Commission#GG 51833
- Commisslon#131351833 9> „o 1_ _
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