HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date;^ Permit Number: i�
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IN
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.IMPROVEMENT LOCAT N;
Address:
Legal Description:
Property Tax ID#: T1!M - ig 00 - Lot No.
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Site Plan Name: ' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Sidef
DETAI, D DESCRIPTION OF WORK: I ;
+0 a
CONSTRUCTION INFORMATION: ,J
rtiona wor to e e Orme er un t is permit—check a appy:
HVAC E]Gas Tank E]Gas Piping _Shutters Q Windows/Doors
ElElectric IPlidmbing Sprinklers 0 Generator 0 Roof Roof pitch
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Total Sq. Ft of Construction: S . Ft.of First Floor
(Cost of Construction:$ I,Wow) Utilities: Sewer S i ptic ; Building Height:
!OWNER/LESSEE: CONTRA C OR. ISI„ ;
Name 1} _ Name: i .
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IAddres Company:
City: ate: Address: i
Zip Code: Fax: City: State
Phone No.41 b '70) Zip Code- Fax:
E-Mail: Phone No.'7 �"
Fill in fee simple Title Holder on next page(if different E-Mail: 1 d �� C�
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 LfEN`LAW INFORMATION:
DESIGNER/ENGINEER: _Not ApplicableNot Applicable
_
MORTGAGE COMPANY:
Name: Name: II
Address: Address:
City: State: City: ! State:
Zip: Phone: Zip: Phone:!
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMP NY: _Not Applicable
Name: Name:
Address: Address:
city: City:
Zip: Phone: Zip: Phone: f
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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 covenantslthat may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for alny 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
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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 ;attorneand posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lendero,r an y before
commencing work or recording our Notice of Commencement.
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,Signature Owner/Lessee/ tractor as Agent for Owner Signature of 1ntract6r/Licen:s04oId.er
STATE OF FLO A . / STATE OF FLORI
COUNTY-OF� DA
11��.Q COUNTY OF - ZW I'll Pte,
The for oing instrut was acknowledged before me The forgoing instr m I n,�jwas jai knowledged before me
this day of m n 20 aby this day of V 1 I 20 by
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Of rex
(Nam I p rson acknowledging) V -(N e)?f rson Acknowledgi6g)
j Signature of Notary blic-State of FI t a) ature of Notary, ub' -State of Florida
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onally Known 't7R Produced Identification ersonally Known OR Produced Identification
F
e LIBERTY&IM ism e of Id ? nypt, ; LIBERTYA.KING
11tY 090838 Commission No. =::I :.e MYCOMMISSIO 090638
Commission No COMANSSf �o�: I EXPIRES:M ,
p(PtR &Itl�y'.__2021 z a r. y 2021
�,'$�,t$•r 'Bonded Thru Notary Public Underwriters
Revised 07/15/2014
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