HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Y
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Building Permit Applicatio
Planning and Development Services
Building and Code Regulation Division ment2300 Virginia Avenue,Fort Pierce FL 34982 , FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click here Y_ C� ,
PRt7FC►SED.INP,R4VEME`Nl' LOCATIQN'� y <_...., ZWO
Address:__ �� � �� 6 ��
Legal Description:
Property Tax ID#: 2 1 0 00 OL-) Lot No.
Site Plan Name: Block No.
Project Name: ¢
Setbacks Front Back: Right Side: Left Side:
-Al TION
Cg[ STRUCTta'tV''INFC►RMATr ,.. ... .". �
Adclitiona1work toe nertormed under this permit-check a' . appy:
HVAC Gas Tank Gas Piping Shutters []Windows/Doors,
®Electric ❑ Plumbing []Sprinklers []Generator Roof
Total Sq. Ft of Construction: Sq,Ft. of First Floor:
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Cost of Construction:$ / G O Utilities: _Sewer E]Septic Building Height:
(�1NNER/LESSEE C�'IUTRACTOR s
Name �� %�,u/.l r� . Name:
Address: S - Company: , ,, , 2., c irc _z 4 ef
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City: 5w -000r^� State:�b Address: �
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p Code: 3 y`/�� / Fax: e�l City: &,49( � � U��P_ State:mac
Phone No. "��� - �('� - /3 /rte Zip Code: 7 t?gr Fax: 1;'g-$P<-e�?6•
E-Mail E�1�..}s_ �,l 1 14- n Phone No. 0,C-1 Gc.0 & --�O -X
Fill in fee simple Title Holder on next page(if different E-Mail: c-_from the-Owner listed above) State or County License:
If value of•construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SU: PLEMENTALCONSTR'U t I ION,UENLAW INFORMATI�}N s{ '° . '
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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 property. A Notice of Commencement must be recorded and posted on t _�
before the first inspection. If you intend to c ncing, consult with lender or an attorney b forte
commencingwork or recordingour Notice Com ncement. �. o ;
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Signature of Owner/Agent/Lessee m�g m Signature of Contractor/License older 6s
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STATE OF FLORIDA ¢ML"R STATE OF FLORI
COUNTY OF =C,')X'- COUNTY OF m
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The forgoing ins t was acknowledged_,,it efore ry The forgoing ins ent was acknowledge�efor
this day of 20 by `� `°'ao this day o 20®by
ex A )e��T L)-t-- o
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Not r Public-State of Florida) (Signature of Notary lic-State of Florida)
Personally Known —OlModuced Idiificati n / Personally Known ORIdentification /
Type of Identification Produce Type of Identification Producedo ced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED