HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
�CITY '
F L Ct R I.:. D. R
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential X'
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: --pt- -I
Property Tax ID #: - t
Site Pian Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No. -
Block No.
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be oerformed under this permit - check all that appy:
L�WHVAC L 1 Gas Tank E]Gas Piping Shutters ❑ Windows/Doors
11 Electric Plumbing Sprinklers E Generator 0 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ OlO "4
S Ft. of First Floor: _
Utilities:Sewer OSeptic
Building Height:
OWN ERAESSEE:
CONTRACTOR:
Name r
Name:
Address: ?1e50\0(_(_ A
Company: k_ ' ' ,
` State:,
Zip Code: Fax
Phone No.
Address:
City:' L
Zip Code: !! __
Phone No.
FCity'C
State: di—
Fax: - -7
E -Mail:
Fill in flee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: ` '� b�
o m C. Jde L
State or County License:
it value of construction is S2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 the jobsite
before the first inspection. If ru intend to obtain financing, consult with lender or an attorney before
commencing work or re ung your Notice of Commencement. A
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-
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signafure of Contractor/License Holder
STATE OF FLORIDA _.,STATE
L
OF FLORID
COUNTY OF_ 4 .
COUNTY OF - . Lun-e,
The for ping instrument was acknowledged before me
this, day of c Sin 20 by
The forgoing instru ent was a knowledged before me
this day of 7 P. ' J. Y 20 by
Name ofp ersorrynakin statement .
Name of persop� making statement
✓
Personally KnownOR Produced Identification
Personally Known V OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of N u i attQe FJJ 1,��
KtL�I WQ�L��
Si natu a u Flori
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Commission No. ; MYCOMMISSION# G2 15fi
� �G � MY COMMISSION #GG242156
Commiss f+ 1 Sea])
EXPIRES: JIJL 2 ,
,2022
Bonded through 1st State Insurance
� Q. Bonded through 1st State insurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17