HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE 1 FO MU E COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: 1 I 1 (0
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 IMP:RO�/EM A Vf
Address:
Legal Description:
10
Property Tax ID#: boo—) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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f DETAILED DESCRIPTION OF WORK ;s f kfk
CONSTRUCTION 1NFORM�4TION
Additionalwork toM.��ank
orme` under tis permit—checkaapply:
❑HVAC ❑Gas Piping _Shutters Windows/Doors
Electric IJ Plumbing Sprinklers E Generator D Roof Roof pitch
Total Sq. Ft of Construction: IN Sq.Ft.of First Floor: I;
Cost of Construction:$ Utilities: I_Sewer Septic Building Height:
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CONTRACTOR� �
Nr,
Name 1 Name:
Address: Company: Ic 1
City: Statetl Address: ' ik. 7
Zip Cod Fax: City: State:
Phone No. b Zip Code: ' 7 I Fax:
E-Mail: Phone N46
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Fill in fee simple Title Holder on next page(if different E-Mail: � DO
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN,LAW INFORMATION: I
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: ! _Not Applicable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone: Zip: Phone: II
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: I
Zip: Phone: Zip: Phone:
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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 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.
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Si atur wner/Less Contractor as At for Owner Signature o Contractor/Lic si Holder
STATE OF FLORID - STATE OF FLORIDA
COUNTY OF . ��(� _ COUNTY OF
The forgoing instrLment
was acknowledged before me The for oing instr,}�nent was alcknowledged b o
this a day of 20 aby this day of 20bre me r
� !, y
(Name o p rson ac nowledging) (Name pe son acknowledgi i g)
(Signature of Notary Pu i -State of Florida) (Signature of Notary Pu c to of Florida)
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Personally Known OR Produced Identificatio Personally Known RProduced Identification
Type of Identi ced LIBERTYA.KINGType of Identificati
Commission «= MYCOMMISSION GQGO 638 Commission No. �q,.�P :°' LIBER?K�G
RES:May �1 COMMISSIMi
Baided Thor Notary Public Underwriters %m;, P;o EXPIRES:May, 2021
�:P °�•` Bonded Thru No
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ! REVIEW REVIEW
DATE
COMPLETE
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