HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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:
Property D . • 0
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK: —1
Supply and l nStall T1evq 50 Qa►lon Y)ybrid Wager Y� C&tt r
1 IR 1-h e
CONSTRUCTION INFORMATION:
Additional wor to be er ormed under this permit- checK all apply: El
CIjjHVAC Ga Jank FGas Piping _ Shutters Windows/Doors
❑ Electric LJ Plumbing Sprinklers a Generator LSI Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 114O`J` •is0
SFt. of First Floor:
utilities. Sewer FSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name )riramt.4 aV ZIfYY'1'B
Address: 5 3d
Name:,Val
Company: p C w
Le' P[ e e, State: EL
City: Forex
Zip Code: 34CL 5 k Fax:
Phone No. `I
Address: rd
City: vtro Be -a on _ Stater
Zip Cade: Fax:
Phone No. 712 - °a 80
E -Mail: R
Fill in fee simple Title Halder on next page ( if different
from the Owner listed above)
E -Mail: Sou th e rn D I V Yn bi AQ -a
State or County License: '-1
If value of construction is $2500 or more, a KELUKULU Notice or Lommencemen( is requires.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: _
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: T Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced priorto the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your playing twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before e first inspection. If you intend to obtain financing ult with lender or an attorney before
com n iz work or recording vour Notice of Commence nt.
jl
_ Sig e of caner/ Les ee/Agent
ntract4fr/License Holder
STATE OF FLORIDA, STATE OF FLORIDA .
COUNTY OF I n I<an .1 V ty COUNTY OF 1 nd i an 9-04 Qr
The forgoing instru gent was acknowledged before me
this Ak*'4 day of 20 1$by
(Nanp9i[Ibn acknowledging
of Notary Publifi State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No. err�2N ryPubl+cSW- olFlor+da
Kristin Kylie Webb
+r MY Commission GG 177258
"3 ^ d' rnires 01I21f2022
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this _6A day of 20 A_5 by
Personally Known ` OR Produced Identification
LLpe of Identification Produced
ission No
e'or � ( 9V Public State of Fiarncia
_ Kristin Kylie Webb
. ^ My Commission GG 177256
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COUNTER
REVIEW
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DATE
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INITIALS