HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO B ACCEPTED
mber:
Date: /
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isustgaing rermlt HPPlicavon
planning and Development Services
,quilling and Code Regulation Division
2300 VIrginia Avenue, Fort pierce FL 34982 Commercial ____ Residential
Phone: (772) 462'1553 Fax: (772) 462-1578
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FERMI 1 APPUC:A I ION FOR: To Select
YROVOSEU IMNKU_V_EMEN 1 LOCAI ION:
Address:
Legal Description:
Property Tax 1D tt:
Site Plan Name:
project Name: Left Side:
Setbacks Front�—
Back: �— Right Side:
UE I AILED UESCKIN I ION OF WORK:
CONSTRUCTION INFORMATION: oermrt -
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HVAC
Gas Tank Das Piping
Electric Plumbing oSP
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Generator
Sq. Ft. of First Floor: _
Total Sq. Ft ofConstruction:
�� � utilities: 0 Sewer Septic
Cost of Construction: $
CONTRACTOR: -
OWNER/LESSEE:
Address: State:`
City:
Zip Code: 0 y 3 Fax:
Phone No. a
E -Mail:
Fail in fee simple Title Holder on next Page ( if different
the owner listed above)
Lot No. ---
Block No.
QWindows/Doors
1 Roof = Roof pitch
Building Height
C �� S p M D'h C ►� � ii
Name: , r S t eV k tic:
Company: C U5
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�,ty State:
3 X452 Fax: 77�?• .J 3 <5- i 4 c
Tip Code:
Phone No. �K St
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E -Mail: C
State or County License:
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D Notice of Comrnencement is required•
it value of construction is $2500 or more, a RE OC Rt3E
SUPPLEM EN I AL C;UNS I RUC I ION LIEN LAW I NFURMA 1 ION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
State:
City: State:
City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
I
' BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Tp: Phone:
I certify that no work or installationas commenced prior to the issuance of a permit.
St- ' ucie Countymakes no representat-on that is granting a permit will authorize the permit holder to build the subject structure
bylaws or and covenants that may restrict or prohibit such
which is in conflict with any applicable Dome Owners Association rules,
structure. Please consult with your Home Owners Association and revie:v your deed for any restrictions which may apply.
with
In consideration of the granting of this requested permit, I do hereby agree that I v?ill, in all respects, perform the work
it-, 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, ..,ails, 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 your Notice of Commencement.
1
Signature of Ogler/.essee/Contractor as Agent for O•rmner I Signature of Contrac`_or/License Holder
I STATE OF FLORIDA r,
STATE OF FLORIDA (,
COUNTY OF ) C ' C 1 +r COUNTY OF
The forgoing instrument wa acknowledged before n>e � The forgoing instrument was acknowledged before me
20 /f by
this 1— day of ,)4a u 20 %f by this day of
. (?u C i<J 55Fi f t1 m p rl S c t i Z T I VV10 t`1
(Name of person ackroviledging j I {Name of person acknowledging)
I � h �� '45yZIC.:
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•tet_ 1 L -`� � '"" - -
(Signature of Notary Public- State of Fic a) l (Signature of Notary Public - Stat of Flo it
Personally Known OR Produced Identification Kno:vn OR Produced Identification
Type of Identification Produced
Type of Identification Produced —
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Commission No_ ga:t4c i «
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Re-vised 0; /1 5i 2014 �, o� EXPIRES: April a, 2021
REVIEWS FRONT ZONING SUPERVISOR I PLANS = VEGETATION SEA TURTLE MANGROVE�#
COUNTER REVIEW REVIEW i REVIEW I REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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