HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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 �i Residential
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PERMIT APPLICATION FOR:
PROPOSED INIPR®UEMENT LOCATIC} y.
Address:
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Legal Description: GCO
Property Tax ID#:\3 Ca � y_ Od1(0" i Lot No.
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Site Plan Name: Block No.
Project Name: i!
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Setbacks Front Back: '� Right Side: Left Side:
DETAILED
OEM ils
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CONSl"R�UCTION IN'�FORMA 10. �"
Additional work to be pertormed under this permit-check all that appy: th i
_Mechanical _Gas Tank _Gas Piping _Shutters �,' _� Windows/Doors
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Electric dumbing —Sprinklers —Generator —Roof Pitch,
Total Sq. Ft of Construction: Sq. Ft. of First Floor: `
Cost of Construction: $ CO co• � Utilities: —Sewer _Septic � Building Height:
N@R/LE�S5 E: CONTRA OR:
Name 4J ?' c L Name:
Address:�ai$( [Zece, 4 arc Company: .I
(City: 44 avec v` C_ State: Address:
Zip Code: Fax: City: I� :,dr,e, �"w", ;�';<" State:
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Phone No. '?72 - _"-3 7( Zip Code: "`= 'Fax!--a
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
'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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SUPPLEMENTALSTR+UCTION UNO-
EN LAUV INF®RMATION:
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DESIGNER/ENGINEER: _ of Applicable MORTGAGE COMPANY: /Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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 our Notice of Commencement. .
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Signature of Owner/L ssee/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this" day of 20($ by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- tate of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identifica� Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L— _- 1 Produced
LA�'�� locida
uuui, hate of F ;
Commission No. ..Po+;c' rotary Q'(Eees pec 20,20is , Commission No., (Seal)
4 My Commissionk« ^749
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REVIEWS F f� jelo% �`"SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
CO E REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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