HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
• I
111111111111110 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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: Qclo (.o (rtj��L� PI,
Legal Description: MCM(\)t\k G 0 0-E C -t 'S;10
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Property Tax ID #: S<6 Q - 0O'.SU - C 0-0 - Lot No.44 +A
Site Plan Name: Block No.
Project Name: ��ntxr% A ct (-y, (ri f\ 0.
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTION INFORMATION:
Additional work toe e Orme under t-checkispermit a appy:
[]GasTank
HVAC ❑Gas Piping _Shutters ❑Windows/Doors
I, I Electric Plumbing ❑Sprinklers Generator Roof ❑ Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
_-3Cost of Construction: $ ,� Utilities:cnSewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: C CHGc'C� --
Address:QX 0,010 C2 l�
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City: KC)CA- ql� V_ CC z State: !L�
Address: Ciquo lQ 4A0,
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Zip Code: Fax:
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E -Mail:
Phone No. CSS
Fill In fee simple Title Holder on next page ( if different
E -Mail: �{ Xi c���C t c� P Ua V\elr C �r
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State or County License:
from the Owner listed above]
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not
Name:
Applicable`
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Public-Staof FloridaCommission
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.
is n confll makes wiany applicabletHome Owners Associatloni ru esabylaws or andpcovenants that may estrict 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 in pection. If you intend to obtain financing, consult w' lender or an attorney before
commencin or recordingour Notice of Commencement
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Sign Oer/LesseeontractorsAgentforOwnerio Contractor/License Holder
STATE OF ORISTATE F FLORIDACOUNTYOF�COUNTYOFThe forgoing instrument was acknowledged before me The forgoing instrument was acknowledgedbefore me
this�dayof20� by this I.S day ofCaf) 20� by
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Personally Known_�OR Produced Identification Personally Kn�OR Produced Identification
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