HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Buildin 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 IIVI'PROVEMENT LOCATIO'N,::
Address: V '
Legal Description:
Property Tax ID#: Z�3363k �_Wy2_ bw_ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side .
DETAILEDf CRIF ORK k
DESPTIONOW �.
CONSTRUCTION INFORMATION lti
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ddAdditional work lobe nertormed under this permit–checK all appy:
11HVAC 0 Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers E Generator E:] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor'
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Cost of Construction:$ yy� Utilities: Sewer El Sel ptic Building Height:
OWNER/LESS mCONTRACTOR
Name f��� Name: �'
Address: 2 Yhcrvl Company: L
City: State:H Address: t 5, i�
Zip Code: Fax: City: -7 State:
Phone No. –777—Z01 e I�9 k Zip Code: 3'1C1 g2 Fax: –
E-Mail: Phone No. -- iz–4_ 3n
Fill in fee simple Title Holder on next page(if different E-Mail: '`,s nY S G �� •C.pYY�
from the Owner listed above) State or County License:�13cm>[W'-G
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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'SIJ PPLEMENTAL CONSTRUCTION LIEN:LAW INFORMATION' s .
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:
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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 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 alny 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
commencing work or recording our Notice of Commencement.
Signa%%ORIDA
er/Lessee/Contrac oras Agent for Owner Signa re Contractor/License Ho er
STASTATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of Se 20� by this day of 201 by
w�
Tame of person making statement Nam4 of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-S&te of Florida) (Signature of Notary obi, tate of Florida)
Commission No. (Seal) Commission No. . iVotary�u��CState oRf Forlda• My Comm.Expires Dec 20,2018 CommI661 n#FFtill c��,... ,,rNotary ublic•State of florl a rough ational Notary Assn.
REVIEWS FROM a ��ICom Ic$Rki5�9R2 18 LANS VEGETAE OVA:.
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DATE Bonded th ougn Nation
RECEIVED
DATE
COMPLETED
Rev. 8/2/17