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: (r V
Legal Description:
Property Tax ID #: 0 ^Ain 0 Lot No.
Site Plan Name: 1 1 /IQ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
S4e
CONSTRUCTION INFORMATION:
AQq!10nal work toa er orme under this permit - check a appy:
H6VAC 11 Gas Tank E]Gas Piping _ Shutters LlWindows/Doors
Electric ❑ Plumbing ❑ Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S�Ft.j of First Floor:
Cost of Construction: $ � /-7 z, ) o Utilities:11 _I Sewer []Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name E
Name:
Addres : IWOq � (c� ���
Company: vo LV
n�
l L
City: , + / I J (1 ! � State:
� S -
Zip Code: 15( f ;x AL1 Fax: r I ,�
Phone No. 'ggn ^ a) - 0 "l (1
Address:D /I
�
City: (r �,�(.�k �(J1 / 1� State:
Zip Code: .31 (6 � Fax:
Phone No. 5_�'p - -91W) 6
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: C a 0V- 4; r, y
State or ounty License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
FRONT
COUNTER
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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, 'ilure to Record a Notice of Commencement may result in your paying twice for
improvements to your prop' rty. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspectio�Y f you intend to obtain financing, consult with le r an attorney before
commencing work or rg` ding your Notice of Commencement.
Signature of
as Agent for Owner
STATE OF FLORIDA /, ��
COUNTY OF 0
The forgoing instrument ws acknowledged before me
this.—day of 20by
}tdr
(Name pf pyrson acknowledging-)-,
re of ItQtaKi Public- State of Florida )
Personally Known OR
Type of Identification P G0
Commission No.
Revised 07/15/2014
ntractor/License Holder
STATE OF_FLORIDA
COUNTY OF Tca aALA=d-_
The fo oing instrument was acknowledged before me
this day of 20 by
(Name of pe son acknowledging )
(Si ature of Nota lic t to of Florida )
n� Personally Known \
FF 93 b Type of Identificatio
mbef 13es-ic,9
a'ona-W"Commission No.
KATHRYN KUJGVDcrnv
Commission ii, rr vouY
Expires No1y3��epah »' 2019
8cn4&4T1m TraJ Fain ln. ante 80038.5-7019
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
IVIANGRO
REVIEW
E
DATE
COMPLETE
INITIALS