HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFOBE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2,300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKMi I AI'I'LICA I IUN FOR: To Select from dropbox, click arrow at the end of line
F'KUNOSEU IMPROVEMEN I LOCAI ION: -
Address: _____._.___.
Legal Description:
Property Tax ID #:
Site Plan Name: _
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Project Name:
Setbacks Front Back: Right Side: Left Side:
Ut I AILEL) DESCRIP i ION OF WOKK:
let,/Ire�,/s�•i!;0
er�e af'C" talc"tom
CONSTRUCTION INFORMATION:
7 i£io ' wor o e er rmed un er is pe�m�t = cl
HVAC Gas Tank Gas Piping
Electric ElPlumbing Sprinklers
Lot No.
Block No.
Shutters M Windows/Doors
ElGenerator i1 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: ,_•
� f 7� Utilities: 0 Sewer a Septic
Cost of Construction: $ ,�
OWNER/LESSEE:
NarAe ' Ti`(
, Q State: �r.
City: r ( S' C_ ° = -
Zip Code: 3 L/5 Fax:
Phone No. i�'� '
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height
Name:
L�)AaVvAcn�
Company:
C u�'rGn1 A �r �u5"IC'4'11S
Address:
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City: Po P --r 9t • L. u c (f-. State: r�
Zi p Code:
3. �t4 59- - Fax: 7 `u-
Phone No.
'7'I a- —33:5' - 3 3 2-
E -Mail:
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State or County License: G �' I $ i' cl
ff value of construction is $2500 or more, a (CORDED Notice of Commencement is required.
SUPPLEMEN I AL CONS I RUC I ION LIEN LAW I NFO}tMA 1 ION:
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: 1
Address:
Address:
City:
City: I
Zip: Phone: i
i
Zip: Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countv 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 exemptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN ING 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.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
" COUNTY OF
COUNTY OF ,S ,L U t'-! i
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The fo going instrument was acknowledged ��}F.fore me The forgoing instrument was acknowledged fore me z
thisday 20 1d by
thisC�dayof �Or—I 20 Lkb�- ofr}�ii
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(Name of person acknowledging j (Name of person acknowledging)
(Signature of Notary Public- State of F1 a) (Signature of Notary Public- State•of Florid
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced _ Type of Identification Produced {
Commission No. G 6 �, ,� 7 a° 1NEB mission No. �i �7 t iI ✓j7 /r%' t^�
MYCOMMISSION1t
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EXPIRES: ;:
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Revised 0"7115i2014 8PM:Apr04,2021
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