HomeMy WebLinkAboutBuilding Permit ApplicationCABL INFO ffiLIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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:
PROPOSED INPROVEMENT LOCATION:
Address: y 3�
fin.
Property Tax ID
Site Plan Name:
Project Name:
Setbacks Front Back:
I DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
echanical
_ Electric
Gas Tank
Plumbing
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Right Side: Left Side:
W
_ Gas Piping
_ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:
Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
OWNER/LESSEE:
CONTR CTOR:
Name 1
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Name: S
Ad ess G
Company:
Addre s:'�
City %+ State:
Zip Code: Fax: �, /
Phone No� — x(p
City
Zip Code:
Phone No.
State:
Fax
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail
State or County License:
If value of construction is 2500 or more, a RECORDED Notice or commencement is regwrea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address:
City: Address:
State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
ZIP: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that nttooy work or installation has commenced prior to the issuance of a permit.
which is fn conflic with any applicableiHothat
e Owners Associpermit
tion rules,bylaws or and ermit covenants that mabuild
y restrict oirr 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 CommencamPnt
Lessee
STATE OF FLORIDA
COUNTY OF
Th oing instrat wt was nowledge fore me
thiday of�_ ZC
person
%Z151 Fewre OT Notary Public- State of Florida)
Personally Knowny/OR Produced Identification
Type of Identification Produced
Commission N
eafl�of,ry pu04o State of
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Com mise,anGG i�
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REVIEWS FRONT ZONING S
COUNTER REVIEW REVIEW
Holder
STATE OF FLORIDA
COUNTY OF
The oing ins r t a cknowledgQd�efore me
thiday of�2t) y
I
(Name of person acknowledging)
-(Signature of Notary Public- State of Florida )
Personally Known � OR Produced Identification
Type of Identification Produced
'-K RNS I VEGETATION rS"Ei('W
REVIEW REVIEW I REVIEW
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