HomeMy WebLinkAboutBuilding Permit ApplicationALL 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 34982y
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:
Address'.
Legal Description:
P
Property Tax ID #: ��40„� -Sn mow' `k Lot No,
Site Plan Name: �R iC�C\ _ Block No.
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Project Name: C`7 (,\
__
Setbacks Front Back: Right Side: Left Side:.
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Addition wor to a er orme under this permit- check all �apply
I Gas Tank []Gas Piping LJ Shutte�r�s Windows/Doors
VAC
11 Electric F1 Plumbing Sprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction: _ SFt, of First Floor:
$ �CD90 Utilities:In Sewer 0Septic Building Height:
Cost of Construction: .�
OWNER/LESSEE:
CONTRACTOR:
Name . i Cis
Name: i
Adds � 1 �c>n '
re
i
Company: _ }
Cit _ State:C?_
Address:
Zip Code: Fax:
Cit State: �Z--
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Phone No.���!•�p�� C��� �� _
Zip Code:' Fax
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E-Mail: _
Phone
E-Mail: t ply15� .Uf
Fill in fee simple Title Holder on next page if different
State or County Llcerise: c_��-1 �D
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION:
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:
f: Phone;_
Zip: Phone:
NER/ 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 dome 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.
wa�&
Signature of caner/ Lessee/Co r for as A en or Owner
Signature of Gbn tractor/ Licens H Ider
STATE OF FLORIDA
STATE OF FLORIQA\
COUNTY OF
COUNTYOF �Q
The forgoing instrument Ns acknowled - before me
The foraging insX ent as acknowledg efore me
`i 20 by
this �, day of � �� 20 by
this day of �, _
Name of person making statement
Name of person making statement
Personally Known_ OR Produced Identification
Personally Known r_--�_OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sign atur of N tary Public- S'Florida
(Signatu of tary Public- State of Florida )
PP����yy
Commission No%'V 60 : (S � JOYCEP11CHALID
tVfYGOMMIS5NON FF i1a3006�
mmission NAT 08 °' Sea YGEMICHAUD
EXPIRES. April 25, 2018
'' � MY COMMISSION A FF 083005,
Bundad 7hnr Nobly Polft unarV14
s tr EXPIRES: April 25, 2018
Banded Dru
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17