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
Legal Description: � � �t,� LOT 1.02 3N73 -216q)
Property Tax ID #: �j"�( �(�! — '- Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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❑HVAC
❑ Electric
Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ Z;7,60
"Shutters
❑ Generator
SFt. of First Floor:
Utilities: Sewer ❑ Septic
Name \
Address: f)zoW -D)lb D Ii101 (1 -
City: �- ak,kld- Ltitlr_ State: FL
Zip Code: _ zggyb
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
❑ Windows/Doors
Roof Roof pitch
Building Height:
Name: 4f V\.
Company:
Add ress:
City: ,S4144'- State:_)�_L
Zip Code: �qf 11 Fax: 17 U7-0 'Y
Phone No. .T
E-Mail:�f d i4' Maj'.MKJi/l4 J✓1(L 1 Z
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 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,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNIN TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improve nts to your property. A Notice of Commencement m i/st be record d and posted on the jobsite
before a first i pectiort. If you intend to obtain financing, co su t ith I n er ora a torney before
comme c' wo r Notice f C
Rev. 8/2/17
re or I our o ice o ommencemen .
blitidlm
Signat o Owner/ Lesse t for as Agent for Owner Signatu of Contractor/Lic ns H I r
STATE OF FLORIDA STATE OF FLORIJp�
COUNTY OF COUNTY OF V��Gi.�� � �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this.�day of th,(is�� day of 20� by
Name of person aking statement � /'� Name of person making statement /
Personally Known OR Produced Identificatibl�✓ Personally Known OR Produced Identification Y
Type of Identification Type of Identification
Produced � Produced
(Signature of Notary Public- St ®RANDI LEMI3C (Sig tur of Notary Public- State of orida) A� B BROOKE
Notar[MR SWQ
y
Public, State of
larida
Commission No.
_
alt OommissionlP FF 243 �TARP ��
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