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: i
Address:
Legal Des
Property Tax lD#: 3LIoLI 1 Q - O0" ('�(Y�" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1C ItXC ince 0+ 2x,5-�-�
KIDSe
Additlonal work to bjrtormed under this permit - check a appy:
VAC �I Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
_ Electric ❑ Plumbing []Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ L ) F G . L -I Utilities:cn Sewer []Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Address:5L t
City:. C( State: FL
Name: (
Company:
Address: Lj
Zip Code: L Fax:
City: 06rr_ c no YJ -P-(-- Stater
Phone No.
Zip Code: 31— )LA Fax:
E -Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:C'a \ C G Lid —ire-{+ I I C an) • C(TO
from the Owner listed above)
State or County License: I<K
va ur uwnxi uuwn a .?c3uu or more, a KtLUKutu Nonce of commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 vour Notice of Commencement.
Signature of Owner/ Lessee/Agent Sigiaf e of Contractor icense Holder
STATE OF FLORIDA STATE OF FLOjRIPA
COUNTY OF y'1� � � COUNTY OF (�. CC -,,C)
The f oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of d t 20��Iby this _aday of 20 J�I by
(Name of person acknowledging) (Name of person acknowledging )
(Sig ' ture of Notar ublic- State of Florida) (Signdiure of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014 I aa?ia ±53
t'YNTHIA CLAY A
MY COMMISSION 0
Personally Known OR Produced Identification
Type of Identification Produced
fission No c� I)
81289 (�ti' CYNTHIA CLAY MCNAI
zur
MY COMMISSION M FF981
••,/,W •I EXPIRES April 12, 2020
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