HomeMy WebLinkAboutBuilding Permit Application � 1
r ALL APPLICABLEFOM ST E COMPLETED FOR APPLICATION TO'BE ACCEPTED II
Date: Permit Number:
0
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 t�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
_EDI zAT=1�/, ;MENT LOCATION:
Address:J- -
Er i r
Legal Description. 0 A Ill s !` f ��
Property Tax ID#: o�`T I () (� (70 �' i Lot No.
"Slie Plan Name.- Block No.
Project Name:.
Setbacks Front .. Back~ Right Side: Left Side: '
li qE=TAILED DE�SCRJPTI®N OF UV�JR°K:
C®NSTR,UCTf®N INFORMATIO : .� '
itiona worto e e Orme un er.t is permit-check a appy:
HVAC D.Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric .0Plumbing Sprinklers 0 Generator EIRoof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
rj
Cost of Construction: $ Utilities: 0 Sewer Septic Building Height:
0 NER/LEjSS.EE: ,_ CO�N�TRACTOR:
Name ' Name: q rZ
Address: `J - Company:-, 14 1/41(i-01A,.c
City: 'State:._ Address: D ,AvW, J ¢Z
Zip Code: :Fax: City: �li�✓'(�'` i` !i State:
Phone No. as'a ., Zip Code: 393) Fax: 9S`�377-Z5(3
E-Mail: •a 1-"'? Phone No. TY` ,'�''17?-9`44P'
Fill in fee simple Title Holder on nek page(if different E-Mail: &S@
from the Owner listed above) State or C t e: NZ7
If value of construction is$2500 or more,a RECORDED Notice of Commencement il bired.
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SUPPLEMENTAL CONSTRU TION 1I'1N LAW I'NFORMATI®N:
DESIGN ER/ENGINEER _ of Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: &S
4afe: City: ate:
Zip: Ph ne. L I I I Zip: Ph ne:
FEE SIMPLE TITLE HOLDER: _Not Ap'licable BONDING COMPANY: i t A plicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has ommenced 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
commenci ork or recording our Notice of Comm enceme .
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SXnatZulre caner/Lessee/Contractor as g f Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF AAA-4—Aly COUNTY OF i Ooq re/L
The for 9gV*��gg instrumen was acknowledged before me The f rgoing inst ment was acknowledged before me
this��'day of .n 1-- 20/"T by this day of 20 1-7 by
(Name of person acknowledging) (Name of person acknowledging)
Signa re otary Public-State of Florida) (Signature o Not r lic-Stat of Florida)
Personally Known OR Produced Identification Personally Known uS OR Produced Identification
Type of Identification�Produced /'-G on Type of Identification Produced
Commission No. 03_f9 'tS(Seal) Commis
Pug Notary Public state of Florida
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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