HomeMy WebLinkAboutPermit Application ALL 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 Ft 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:
Legal Description:
c-
Property Tax I D#:
Site Plan Name: Lot No.
Project Name: Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona wor to e e orme un er t is permit—c ec a a
pp y:
HVAC Gas Tank []Gas Piping _Shutters
Windows/Doors
Electric Plumbing Sprinklers EJ Generator 0 Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ ` � n
Utilities; Sewer I�JSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name \ ` Name:
Add ss: �G ) -41 �(� _ Company:
p y:
City: State: L-
� Address:
Zip Code: Fax: City:
Phone No. — q 6 1�77 Y - Stater--
Zip Cp : Fax: —
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: �.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: I 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:
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 ,pasted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing wo-rLQr recor ' tice of Commencement.
s
Si wner/Le§4e/AgPA ign ture o nse Holder
STATE OF FLORIDA STATE OF FLORIDA "
COUNTY OF COUNTY OF �Vrt�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ALVXX 20 1 by this day of S , 20 1( by
r-
(Name of person acknowledging) (Name 7erson acknowledging)
Signature of Notary Public-State of Florida ) (Si nature of Notary Public-State of Florida)
Personally Known OR nally Known—1 1R Prod ced nti iNotao Pu to of Type of Identification Produce Notary Public State of frjori aTy of Identification Produced r
My Commis on GG 1381 1 c My Commission GG 136118
Commission No. 1 VV'S€01'e's 08/20/2021 Co,mission No,LIQ of ealf"Pi—D'2a2021
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS