HomeMy WebLinkAboutWeisman-Building_Permit_Application pg 2 ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ____________________ 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:
PROPOSED IMPROVEMENT LOCATION:
Address: __________________________________________________________________________________________
Legal Description: ___________________________________________________________________________________
__________________________________________________________________________________________________
Property Tax ID #: _________________________________________________________________ Lot No.__________
Site Plan Name: __________________________________________________________________ Block No. _______
Project Name: ______________________________________________________________________________________
Setbacks Front__________ Back: _________ Right Side: _________ Left Side: ________
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit – check all that apply:
__ HVAC __ Gas Tank __ Gas Piping __ Shutters ___ Windows/Doors
__ Electric __ Plumbing __ Sprinklers __ Generator ___ Roof
Total Sq. Ft of Construction: ___________________ Sq. Ft. of First Floor: _________________________
Cost of Construction: $ _____________________ Utilities: __ Sewer __ Septic Building Height: __________
OWNER/LESSEE: CONTRACTOR:
Name__________________________________________
Address:________________________________________
City: _________________________________ State: ___
Zip Code: ______________ Fax:____________________
Phone No._______________________________________
E-Mail:_________________________________________
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: __________________________________________
Company: _______________________________________
Address: ________________________________________
City: ______________________________ State:____
Zip Code: ________________ Fax: __________________
Phone No. _______________________________________
E-Mail: __________________________________________
State or County License: ____________________________
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ___ Not Applicable
Name: ______________________________________
Address:_____________________________________
City: _____________________________ State: _____
Zip: ___________ Phone: _______________________
MORTGAGE COMPANY: ___ Not Applicable
Name: ______________________________________
Address: ____________________________________
City: _____________________________State: _____
Zip: __________ Phone: ________________________
FEE SIMPLE TITLE HOLDER: ___ Not Applicable
Name: ______________________________________ Address: ____________________________________ City: ________________________________________ Zip: ___________ Phone: _______________________
BONDING COMPANY: ___Not Applicable
Name: __________________________________________
Address: ________________________________________
City:____________________________________________
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 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 your Notice of Commencement.
__________________________________________
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA COUNTY OF_________________________________
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known _______ OR Produced Identification ______
Type of Identification Produced__________________________
Commission No. ______________ (Seal)
__________________________________________s
Signature of Contractor/License Holder
STATE OF FLORIDA COUNTY OF___________________________________
The forgoing instrument was acknowledged before me
____ bythis ____ day of _________________, 20
____________________________________________________
(Name of person acknowledging )
____________________________________________________
(Signature of Notary Public- State of Florida )
Personally Known _______ OR Produced Identification _______
Type of Identification Produced___________________________
Commission No. ______________ (Seal)
REVIEWS FRONT
COUNTER ZONING
REVIEW SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this ____ day of _________________, 20 ___by
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name-,
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ` Not Applicable
13ONDING COMPANY: Not Applicable
Name:
Name:
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 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,
accessary 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 far
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
commencine work or recording your Notice of Commencement. -�
_ Sign re of ner/ Lessee/Agent
rise Holder
STATE OF FLORIDASTATE OFLORIDAF
COUNTY OF -3 _ _u c, COUNTY OF S'"i
The forgoing instrument was acknowledged before me
this day of _ 20 --by
(Name of person acknowledging)
—k��
ignature of Notary Public- of Florida j
Personally Known ✓ OR Produced identification
Type of Identification Produced - __
The forgoing instrument was acknowledged before me
this day of
20 by
C° CSS ll
(Name of person acknowledging)
(SEgnature of Notary Public- Stat orida j
Personally Known V, OR Produced Identification
Type of identification Produced
�R RINti ATHER RING
Commission No, Commission No. hiivfl55[ON!{FF144529
a SSION # FFI40529
ox�cF EXPIRES: July M 2020 EXPlk135: 3uty 10, 2620
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS