HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
O J ii
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:
Legal Description:
�1
Property Tax ID #: l ! Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
S all r,-) 7zin ly,5seer 10 Kw
CONSTRUCTION INFORMATION:
Additional work oe orme under tispermi —check a appy:
❑HVAC 11GasTank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof ❑ Roof pitch
Total Sq. Ft of Construction: SQI Ft. of First Floor:
Cost of Construction: $ Utilities: I❑ Sewer ❑ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name .i Z�PapcknName:
Address: CAoeCompany:
� C
Addre s: VJ rPyfr_cink:A1P_ 'Pt
City: State: \
Zip Coder Fax:
City: State:
Phone No.(:�) 1 �j �q t
Zip Code: Q Fax:
E -Mail:
Phone No.(—)—) —
Fill in fee simple Title Holder on next page ( if different
E -Mail:
from the owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
MANGROVE
Address:
COUNTER
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:
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 wnsiderati9n 9f the granting 9f thii requested permit, I do hereby agree that I will, in all re5pert5, 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
commend++ work or recordina vour Notice of CommencemenY!Ii
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLO, IIA
COUNTY OF .
The forgoing Instrument as acknowledged before mi
this da of 20
(Name of persoqLiiicknowledging )
s
Signature of Contractor/License Holder
STATE OF FLORIDA .
COUNTY OF
The forgoing instrument was acknowledged before me
this 9 b day of� 20 )D_ by
(Name
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica ion Produced Type of Identification Produced
Commission No. KUCHTA Commission No.
_M Y COMMISSION # GG044970"•MARY KUCHTA
EXPIRES Novem r
Revised 07/15/201 EXPIRES November 03.2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS