HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
BuildingApplicationPermit
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
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Property Tax ID#: Lot No.
Site-Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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PitHVAC
i na wor to e er orme un ert is permit—c ec a app y:
Gas Tank Gas Piping In Shutters Windows/Doors
Electric Plumbing Sprinklers _Generator [].Roof Roof.pitch
Total Sq. Ft of Construction: Sc. Ft.of First.Floor:
Cost of Construction: $ Q�Q 0 Utilities: Sewer Septic Building Height:
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Name ,(°���..✓°'` Name: lo� Y-YI
Address: va$ '��,' �� - �t„�2� Company:fnc' , '�`C� I Q
City: pas\.. State:FL... Address:uLk �1-�--
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Phone No. 's Q ., Zip Code: ?)Lk-ct` Fax: ' l
E-Mail. Phone No. as k D
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Fill in fee simple Title Holder on next page(if different E-Mail: �-�: (�:c:. -�r1 G �r✓.
from the Owner listed above) State or County License:.0 (2,l
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not 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.
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, l do hereby agree that I will,in al-1 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 your Notice of Commencement. :
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contra-Ro"-'r1mmsedff �
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20 by this day of /71) — -a. ,20 L6 by
Name of person making statement ;N,arne of person making statement
Personally Known OR Produced Identification �P_e..rsonally KnoUvn `: = OR Produced Identification
Type of Identification Type of"'Idien
Produced Produced _
(Signature of Notary Public-State of Florida) (Signature f Npita ',public-St AVQ P
Notary Public State n1 Ft ida.
Commission No. (Seal) Commissio N •: COm sion# GG qq�2
9r ��°; My Comm. Expires Jul 25,202Q:
y#00 F�;o��`
Bonded through National Notary Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17