HomeMy WebLinkAboutBuilding Permit Application ALL APPLICP B1EIN10t ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
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Date:
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6Uilding Permit Application
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Planning and Development Services ;(
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 R@eSidential
Phone:(772)462-1553 Fax:(772)462-1578 Commercial �s .�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at tl16,�end of line
PROPOSED iMPRtJU;EMENT LOCATION j
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Address:
Legal Description:.,- -
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PropertyTax ID#: f 72- f it Lot No.
+ Block No.
Site Plan Name:
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Project Name: � `I
Setbacks Front Back: Right Side: Left Sid�tly' r(�
(1 t1 y k 4 } N,
DE A4L7" DESCRIPTION OF WORK r n
CQNSTRUCTIONINFORMATION k� ,
Additional wor to e e orme under this permit-check a _appy:
HVAC Shutter_"13 ❑ p
Windows/Doors
( F(IE]Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq., Ft.of First loer:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
O#UUNER/LESSEE « ' , ' CONTRAC dR xt
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Name Name:
AddresCompany:
!011son
City: State: Address: '
Zip Code: Fax: City: h
[ t t ( Stater
Phone No���_'-t�,p�'-t - boo Zip Code: i L ;'�"7�j
' Fax
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
license"
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from the Owner listed above) State or Ca B '
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If value of construction is$2500 or more,a RECORDED Notice of Commencem p�.! U�
F Iso
-SUPPLEMENTAL CONSTRUCTION LIEN,LAW INFORMATION ;!
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: !
Zip: Phone: Zip: Phone:
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.
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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
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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 our Notice of Commencement.
Sign of Owner/Lessee/Contractor as Agent for Owner Sign r of Contractor' License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF— � COUNTY OF �
The f r i g instr e w a kno ledg fore me The f g instr nt w cknowledg fore me
this ay of 20by this ay of 20
M �
erson making statement am son Imaking statement
—:
Personally Kno OR Produced Identification ersonally Known OR Produced Identification
e o Identification Typeca ion
Produced Produced
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(Signature pq�15TMpcaf��iaizf1prida (Signwii7
y =# P0.Y Pre i,
* Commission#FF 234730 to gro* *��: otary Public-State of Flor a
Commissi�o "o r. 4 F Aires Maf-Wag015r Commis$o * ,: , m�;� ,, Jaen)
4l� o��' - FF 234735
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Bonded through National Notary Pssn.;"r 1; f. P
oFe M Comm.Expires Na 27.2015
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17