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
Address: %.Cf V)er bre�� lc�)il ve-.0
Legal Description: 131 a— 801— i0433 ! C
Property Tax ID #: 131y`—a D 1 —C,)945;L& —cce Lot No.
Site Plan Name: Block No.
Project Name: I n o e-?
Setbacks Front Back: Right Side: Left Side:
Tn&V_4 1 40 coal t n .ur I�� e.r �l I�Q .�,cyo�a-n�lan
ditional work toUe e orme under this permit- check a appy:
HVAC Gas Tank E]Gas Piping Shutters ❑Windows/Doors
_
Electric ElPlumbing OSprinklers Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ )1yDO ip Utilities: Sewer El Septic Building Height:
Name(S! 0M
Name:
Add ress:52-0_�'P
Company: mo) iQ /oil -
City: �•-L' Pierce- State:�L
"7
Addr. 24345 '-J I'��' u-- f -700
Zip Cod Fax:
Cit I`I "E'er State:1CL___
Phone No.540 1- -74(p -t 146D
Zip Code:3>54 0cl Fax:
E -Mail:
Phone No. J ) r -i*P`" USC)
Fill in fee simple Title Holder on next page j if different
E -Mail -.4 eadnll ro I Q ILUXIOIP 'hal
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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.
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 thepermit 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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin ork or recording our Notice of Commencement. 67�
1\ce:51 -
Rev. 8/2/17
Signature o caner/ Lessee/Con actor Ag for Owner Signature of Contractor/License Hold
STATE OF FLORMA- STATE OF FLO
COUNTY OF COUNTY OF
The f ru nt was ac cn wledged ore me The fo strumen was acknowled efore me
this n3ayof 20 b this ay o 20� by
Name of p r making statement Name of pers n making statement
Personally Known OR Produced Identification Personally Known � OR Produced Identification
Type of Iden ' icatio Type of IdeM'f' do
Je d < < � `�l Produced
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re of Nota Public- State of Florida) (Si )ure ofNotaryublic- Stateolorida`CommissionN TA
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