HomeMy WebLinkAboutst lucie county 1.2.2018.pdf1ANLL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit (umber:
Building Permit Application
Plonning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462- 578
Commercial
Residential
PERMIT APPLICATION FOR* To Select from dre box, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax l :
Site Plan Hare:
Project tare:
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Setbacks Front Back: Right Side:
DETAILED DESCRIPTION OF WORK:
:
CONSTRUCTION INFORMATION:
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❑HVAC
Electric
to bfl
rtorrned
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
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under this permit —the
❑Gas Piping
Sprinklers
Lot No.
Block No.
Left Side:
an Inal ppi :
Shutters
❑Generator
Sq. Ft! of First Flour:
Utilities: Sewer Septic
QWindows/Doors
DRoof
Building Height:
Roof pitch
OWNER/LESSEE:
CONTRACTOR:
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Name_ f .0
Name. .�
Address.
Company:if I{ r,
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Zip Code! Fax!
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City: _.'�A P `� State:
Phone No.
Zip Code! Fax:
E -Mail:
Phone No. '� f 0
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 500 or more, a RECORDED Notice of Commencement is required!
SUPPLEMENTAL CONSTRUCTION LIEN LA's' INFORMATION:
ESI ER/ENGINEER: blot Applicable
MORTGAGE COMPANY. PA► . I of Applicable
Name: arse;
Address: Address:
City: ... - State: City.. State:
Zip: Phone----,.�, Zip: _ Phone: r
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
rye:
Address: Address:
City: City..
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFID IT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie bounty rakes no representation that is granting a permit will authorize the parr a holder to build the subject structure
which is in conflict with applicable Hoge 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 wort
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 paring twice for
improvements to your property. A Notice of Commencement rest be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with leader or an attorney before
commencing or recordingyour Notice of Commencement.
Signature of weer/ Lessee/Contractor as Agent for Owner Signature ofConi-r-
or/License Holder
STATE OF FLORIDA STATE OF Fl I A
COUNTY of COUNTY of
The fo7da
ing instru e t was a owledggd efore me The for ing instrument was ac n wledge fare rr�e
this of � 9 o� by this f �'� ( bar
Name of personJng statement. Name of person mall statement
Personally Known R Produced Identification Personally Known R -Produced Identification
Type of l d entifitidI
Type of Identification
Produced Produced
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off" mis ion No. •,, �•* �� ��� o mmission Flo. s *., ,.1. 1 � 2021 May 4t BwAaron Notary►Aan Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW IEW RE I'IEW REVIEW
SATE
RECEIVED
ELATE
COMPLETED
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