HomeMy WebLinkAboutBuilding Permit Application ALL 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 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
PROPOSED IMPROVEMENT LOCATION:
Address: �� y
Legal Description:Du—,r , rtun I�-Q rAr"l o-0>:1 tL /`7 (E.J 1
Property Tax ID#: I �'� 1`1 �vc� �JLJ SCJ Lot No. �
Site Plan Name: Block No.�"I
Project Name:� cf)
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Sub �Por�k 10-
CONSTRUCTIONUCTION INFORMATION: .
Additional work to be nertormed under this-permit—c ec allt=appy:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing U Sprinklers E]Generator 1:1Roof Roof pitch
Total Sq. Ft of Construction:
Y� S Ft.of First Floor:
Cost of Construction:$ I( x'y-, Utilities: Sewer Septic Building Height:
OWN ERAESSEE: CONTRACTOR:
Nam Name:
Address: n
, �Mr Compan : c —�
City: ' O State: Address _
Zip Coder` Fax: City: (-Y- k I State:E-1
Phone No ,�a 'c qg� Zip Code Fax:
E-Mail: Phone o. �90K Lo
-
Fill in fee simple Title Holder on next page(if different E-Mail. P Tf C-0 -
from the Owner listed above) State or County License: I� 4
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 TITLEHOLDER: _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 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 exempt from undergoing a full concurrency review:room additions,
accessorystructures,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.
�. r—--
Signatur of Owner/Lessee/Contractor as Agent for Owner Signatur6 of Contractor/License Holder
STATE OF COUNTYOF FLORIDA ���. COUNTY OF STATE OF FLORIDA
The forgoing instrument was acknowledged before me The forigoing instrument was acknowledged before me
this
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Name of person making statement Name of erson making statement
Personally Known )• OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatu )> Notary P lic-State of Florida) (Signatur ota y Pub -''S/ltate of Florida)
Commission No. FF N (Seal) Commission NoT71 C4 � �'V6� (Seal
R �,,,,,,,, HOLLY BURGESS.
,``�a'°�e�,, piihiir-State of Florida
Pbe� „• S atelNotary
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REVIE ?=t• pl��'.. Y; "Z06N t S ERVISOR PLANS b� g ��it$111n908, GROVE
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DATE ;,; ;ional sn.
RECEIVE '`n'
DATE
COMPLETED
Rev.8/2/17