HomeMy WebLinkAboutBuilding Permit Application All APPLIAB��1E--��INFO Ij UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'C� �`
Date: (b9 ( I \7 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:
PRCIPOSSEnED lNP"-OVEMENT LOCATIQN
Address: `'-S G&a
T
Legal Description:
Property Tax ID#, � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESSCRIPTION OF WORK 1 ;
CONSTRUCTION INFORMATION
i �
Additionalworkto a er orme un er t is ermit-c eck all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ c),\ m Utilities: —Sewer _Septic Building Height:
01NNER/LESS.EE == -CONTRACT'. i I
Name !� owe t Name:
Address: oL \9 k���l �y� �'Da ` Company:
City:, State: Address:��`1 SO C 6r�
Zip Code: J3 Fax: City: State:—I-/(,—
Phone No. Zip Code: 3 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.
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SUPPLEMENTALCONSTRUCTION LIEN LAW INFQRMAT10
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.
St. Lucie County makes no representation that is granting a permit will authorize thepermit 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 anotf er 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
commjNiqng wgirk or recording our Notice of Commencemen .
r
ure of Owner/Less ractoras Agent for Owner Signat of Contractor/Lice olderE OF FLORI i SATE OF FLORID ) I
COUNTY OF l.� Cly COUNTY OF L, C-
The forgo'ng instrun t was a knowledg efore me The f rgging instr ent was acknowled efore me
this y of 20by thisay of 20by
C-1 LPA l l
(Name of person acknowledging) (Name of person acknowle ging)
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(Signat ry Public-State of Florida ) (Signature of Not Public-State of Florida)
ersonally Known OR Produced Identification Per ally Known OR Produced Identification
entification T of Idif
Produced Prodated—
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014