HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED; J
Date: Permit Number:
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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 iI Residential
PERMIT APPLICATION FOR: P
To Select from dro box, click arrow at'the end of line
PROPOSED IM'PRQyEME'NT LgCATfC!N
Address: v I1 I
Legal Description:
1Property Tax ID#: l c�V1 � �- wO�i —� Lot No.
Site Plan Name: Block No. L6
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Project Name:
.Setbacks Front Back: Right Side: Left Side:l I
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DETAILED DES'CRI`PTION:OF US/OkK. t; i
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GQNSTRUCTION INFORMATION
Additional wor to e e orme under this permit-c ec' a a appy:
❑HVAC _Gas Tank []Gas Piping _Shutters ❑Windows/Doors
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Electric ❑ Plumbing []Sprinklers ❑Generator ,j E] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
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Cost of Construction:$ �� Utilities: _Sewer❑septic i Building Height:
:.OWNER/LESS,EE .CONTRACTOR;I"d
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Name ( ov Name: II
Address: 66 Company: (' 6 i L
City: \ State: Addres ' l W
Zip Code: Fax: City: ivu State:
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' Phone No. `--C��- � D- e, A� Zip Code: 1U_ Fax n7 —4CP
E-Mail: Phone N ��
Fill in fee simple Title Holder on next page(if different E-Mail: _ GAJ C��
from the Owner listed above) State or County LicenseL ) 0 0 L24
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.'
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SUPPL'EME(VTAL CONSTRUCTION LIEN LAWIN' ,ORMATI
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY- ! _Not Applicable
Name: Name:
Address: Address: I
City: State: City: State:
Zip: Phone Zip: Phone: i {
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: ! i _Not Applicable
Name: Name: I�
Address: Address: it I
City: City: I I
Zip: Phone: Zip: P one: I`
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do theework 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 holderi 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
iin accordance with the approved plans,the Florida Building Codes and St.Lucie County All endments. ;I
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 Mies to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result iin 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 o,r an attorney before
,commencing work or recording our Notice of Commencement.
C Li I I r
Signa re Owner/Lessee/Contractor as Agent for Owner Sign u e of Contractor/Licerise Holder
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STATE OF LORIDA STATE O FLORIDA
COUNTY OF COUNTY OF II
The forgoing instrument was acknowledged before me The forgoing instrum nt was;acknowledged before me
this day of 20_ by this day of 20_ by
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Name of person making statement Name rof person making statement
Personally Known OR Produced Identification Personally Known 11 OR;Produced Identification
Type of Identification Type of Identification'
Produced Produced
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(Signature of Notary Public-State of Florida) (Signature of Notary;Public-State of Florida)
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Commission No. (Seal) Commission No. i (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 i
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