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HomeMy WebLinkAboutBuilding Permit Application I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Per it 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: PROP(a3SED IN'P OUF�MENT ffle GIN: Address: Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAI�I.ED DE:�SCRIPTION OF WORK: CUNSTR�UCTI�N IN1=aR,MATIDN: Additional wor to be per Orme un er.t is,permit—check all that appy: _Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors _Electric _Plumbing _Sprinklers Generator _Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction:$ �i`l d Utilities: _Sewer _Septic Building Height: DOWNER SEE: CONTRACT©R: Name I/e �/�1` Name: / )Poco� Address: Company:_ dmf �7`�`/fi7lr�G—� enc/v City: Stater Address: X7 c>c) Zip Code: 7 ��� Fax: City: 11 / �e State: f C Phone No. 2�� � Zip Code: G/S C Fax:: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail //k alCe � c. • ( — from the Owner listed above) State c r County License 6(1-c If value of construction is 2500 or more,a RECORDED Notice of Commenc ment is required. 7 SUPPLEMEN11 AW I'NFC7ROT,010: 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 WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your pr perty. A Notice of Commencement must be recorded and posted on the jobsite before the first inspectic . If y intend to obtain financing, consult with lender ran ney before commencingwork or r or our Notice of Commencement. Vinaturle of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF d COUNTY OFa� The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this day of 20_ by Name of person ma011g statement. Name of person making tatement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced ( atu a of Notary Public-State ttf Florida) (Signature of Notary-Public,_State=o`.lorida� "' LASIIAHNA INGRAM Commission No. Seal Ij Notary Public•(S`e01)i Florida _.( ). —Commission No.c. _ , = I , •_M Comm.Expires LASHAHNA INGRAM .c '��t; Y p Dec 20,2 on fir_Siata orifi Commission #FF 177244 •#a _ J;`' = PAV Comi�.Expires Dec 20,2!18 t� " Bonded through National Votary Assn. REVIEWS FRON Npl RINGComrii:S:UPE�R-VISOR9 `PLANS VEJ�T�LS A'TlJ'RTLE` -1VIA(VGf OVE COUNT- �, IEWndedthougiREVIEWtaryA!s EVIEW REVIEW REVIEW REVIEW DATE .. RECEIVED DATE COMPLETED Rev. 8/2/17