HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4 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: TIC
Legal Description: ti
Property Tax ID #: Lot No.-.-_—
Site Plan Name: _ Block No.
Project Name:
Setbacks FrontBack: _ Right Side: _ Left Side: _
LDETAILED DESCRIPTION OF WORK:
" CONSTRUCTION INFORMATION:
�itior.ia woa` to jeDer orme under this permit -check all apply:
Tank E]Gas Piping Shutters ❑ Windows/Doors
HVAC I �I Gas _
Electric Plumbing Sprinklers Q Generator E]Roof Roof pitch
Total Sq. Ft of Construction: Sq, Ft. of First Floor: J
0 11
Cost of Construction: $ Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company:
Addr •
City:ss: ►
State: (�.-ddress:
Zip Code: � Fax:
City: C�•x State.
Phone No. _
/
Zip Code:'�'� -c�"+q `I
E-Mail: _
_Fax:
Phone No.-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: � � C I y%
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
REVIEWS
Address:
City: State:
City:
State:
Zip: Phone:
VEGETATION
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable BONDING COMPANY: Not Applicable
Name:
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
commencine work or recording vour Notice of Commencement.
s
_ Signature of Owner/ L e Age t Signature of ContractorlLicens older
STATE OF FLORI A STATE OF FLO A
COUNTY OF G` COUNTY OF
The f r oing instrument Vais acknowledged before me The forgoing instrument was acknowledged before me
this day of 20'Tby this ! t day of ell,20 by
(Name of person acknowledging) (Name of person acknowledging )
(Sign ure & Notary Public- St e of Florida) (Signatur u) ary Public- State of Florida )
Personally Known L -----OR Produced Identification Personally Known "Produced Identification
Type of Identification Produced Type of Identification Produced
rvy`¢ j JOYCE MICHAUD r;ik��"' JOYCE MICHAUD
`*�� (Se MY COMM ISSION#FFO&MM mmission No. � aI�1YCOMM,SSION#FFO
Commission No. ,
�" EXPIRES: April 25, 2018 _:� EXPIRES; April 25, 2
Bonded Thru Flalary Pi0ld r unAnwrs g. `: Bonded Thru f:o�a y f�ub c flna
Revised 07/15/2014
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS