HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PROPOSED IMPROVEMENT LOCATION:
W>
eg 3l Description:
11roperty Tax ID #: 1 Lot No.
Site Plan Name
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CON TRUCTION INFORMATION:
CONTRACTOR:
Name
i ona wor to e e orme under
1
this permit –check
a appy:
Company:
HVAC Gas Tank
C]Gas Piping_
Shutters
F]Windows/Doors
11 Electric 0 Plumbing
E]Sprinklers
a Generator
R
Zip Code:
Fax:
E -Mail:
Roof
Total Sq. Ft of Construction:
Fill in fee simple Title Holder on next page ( if different
S Ft. of First Floor:
-'
Cost of Construction: $ [,;(p
Utilities: Sewer — Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name.�_LL
Address.,
Company:
City: XD1 State: i ,
Address.
Zip Code: Fax:
City: ®
State:,,..
Phone No.
Zip Code:
Fax:
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 LicenseC
r
AC 1
tf value of construction is tiZsoo or more, a RECC;RDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: vNot Applicable
MORTGAGE COMPANY: ---
� Not Applicable
Name:
Name:
Address:
ZONING
Address: �-
City: State:
VEGETATION
City: State:
Zip: Phone:
_�-
Zip: Phone:
REVIEW
FEE SIMPLE TITLE HOLDER: _,L_ Not Applicable
REVIEW
BONDING COMPANY: Not Applicable
Name:
REVIEW
Name:
Address:
_
Address:
City:
City:
Zip: Phone:
COMPLETE
Zip: _ Phone: -�
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
efore the first inspection. If you intend to obtain financing, consult with lenderor amattorney before
commencing ",,r� or recording your Notice of Commencement. 7�
Of
Contractor
STATE OF FLORIDAI STATE OF FLORRA►.
COUNTY OF .C„ � co t_d� !i; {'���o COUNTY OF " QAt" F -)
The forgoing instrument was acknowledged before me
this_;'day of r lXslL 20 F`9N by
(Name of
The forgoing instrument was acknowledged before me
this 15 qday of ��>'L /s , 20 i_ by
a
\ 'a "
(Mameperm acknowledging
S
(Signature of N61aq-Flt ieS-St o 4 � (SSignature of Notary PWk-Mate of Flor`q�,j aril j
` �•. / \
Personally Known OR P*uc� \ Personally Known V OR Pro`�N�¢teten
T e of Identification Produced 1 e 're # N- Type of Identification Produced
yP S.�'u
Commission No. �'r (I�, _ Commission No. (Seal)
�a Bon €GG 10%U Z
Revised 0701502014 ///&/C,S?A\
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IINIIItNt
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
®ATE
COMPLETE
INITIALS
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