HomeMy WebLinkAboutBUILDING PERMIT APPLICATONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED —0Y
Date: Permit Number: I(
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
P,Ri7`POS'ED.IMPROVEMENT LOCATION;
Address:
Legal Description:
Property Tax ID #: 3CW__ (COI - nm7-- � C) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
a DETAILED DESCRI°PTIO4N OF WORK � }
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CONSTRUCTION INFORMATfON
Additionalwork to be nertormed under this permit- check all appy:
HVAC L_J Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
QElectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities:Sewer OSeptic
Building Height:
OWNER%LESSEE ;_''CON
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Name:
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Address:
Company:
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City: State:
Address:
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City:
State:
Zip Codez Jit a_?- Fax:
Phone No.
Zip Code:
Fax:
E -Mail:
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Fill in fee simple Title Holder on next page ( if different
E -Mail:
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from the Owner listed above)
State or County License:,Uu
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
:SUP PLEIVIEN.TALCONSTRUCTION LIEN LAW IN;F,ORMATIO.N:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 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 vour Notice of Commencement.
Rev. 8/2/17
Signatu Owner Lessem on a as Agent for Owner
Sign t e o ontractor
icense Holder
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17