HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Prone: (772) 462-1553 Fax: (772) 462-3578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbcx, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: LrLa,, fj�rS%��S l i`.2� f�><�%��
Property Tax ID #: Lot No.
Site Plan Name: Block No. t �-
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Total Sq. Ft of Construction:
Cost of Construction:
S Ft. of First Floor: _
Utilities. Sewer 0Septic
Building Height-
OWNER/LESSEE:
CONTRACTOR:
Mame ] C hl_ _
Name:
Address: 3 1 ! 1. wee C
Company.
City: I e '(a n Vin` _ State: tt �'
Zip Code: Fax: k) 1A .
PhoneNo. �-j C _ 7 ;�
Address:
CONSTRUCTION
INFORMATION:
State:--L-
tate:I'Phane
�1(y b Fax: ,1Jf
IC - i S --
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
Additional work
VAC
toe e orme under this permit �- check a
[] Gas Tank Gas Piping
apply:
Shutters
Windows/Doors
ffElectric
®Plumbing
Sprinklers
E]
Generator
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:
S Ft. of First Floor: _
Utilities. Sewer 0Septic
Building Height-
OWNER/LESSEE:
CONTRACTOR:
Mame ] C hl_ _
Name:
Address: 3 1 ! 1. wee C
Company.
City: I e '(a n Vin` _ State: tt �'
Zip Code: Fax: k) 1A .
PhoneNo. �-j C _ 7 ;�
Address:
Lk -(r
City:
Zip Code:
Phone No.
State:--L-
tate:I'Phane
�1(y b Fax: ,1Jf
IC - i S --
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
E -Mail: G
State or County License:
It Value of construction is 57500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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 l 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 you intend to obtain financing, consult with lender or an attorney before
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Rev. 8/2%17
Siggattife o . ess f r as erit t Dwia,�r
magna# icense Holder
STATE OF FLORIDA
STAT OF FLORIDA
COUNTY OF i s
COUNTY OF
The forgoing instrument was acknowledged before me
this � ay of {�¢c.y�iJ 20 (.}� by
The forg ging instrument was acknowledged before
this day of %ep1 i2 fyA _ , 26
me
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Name of persog making statement
Name of pmaking statement
Personally Known ` OR Produced Identification
OR Produced Identification
Personally Known _:7—
Type of Identification
Type of Identification
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ignature of Notary Public- State of 'Florida)
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ignature of Notary Public- State of Florida)
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Rev. 8/2%17