HomeMy WebLinkAboutBuilding Permit ApplicationALI. APPLICABLE INFO MUST BE COMPLETL.'_ _iR APPLICATION TO BE ACCEPTED
Dente: � � Permit Number:
Building Permit Application
Planning and Development Services
8t,ilding 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 IMPRO EMENT CATION:
Ad c ress: , U__)
Legal Descjption:-
Property Tax ILD #: - — s Lot No. 0J)
Site Plan Name:. Block No. _
Project Name: (����
:Setbacks Front Back: Right Side: Left Side:
F DETAILED DESCRIPTION OF WORK:
[CONSTRUCTION INFORMATION:
4ac iti na work to ff!GasTank
orme urider t is permit - check a appy:
HVAC []Gas Piping _ Shutters ❑ windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cos: of Construction: $ b Utilities: 0 Sewer 0 Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Narne
;r.� r
Name:
Adcress: li-A
Company•
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City: Yi
state: �L
Address.
City:
Stater
Zip Code: Fax:
Phone No. 1_�LJL
Zip Code: Fax:
Phone No.
E -Mail:
E -Mail:
mill in fee simple Title Holder on next
page ( if different
State or County License:
Q
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from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUP" 8 C:;3
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
ZONING
Name:
PLANS
Address:
SEA TOWKIL""
Address:
City:
State:
City:
State:
Zip: Phone:
REVIEW
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 a posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lende or -tan attorney before
commenciniz work or recording vour Notice of Commencement/
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
Signature of Contractor (cense Holder
STATE OF FLORIDgr'� \�
COUNTY OF C rn
The for pq�iing instrument was acknowledge efore me The forging instrument was acknowledged before me
this ''day of 20 by this day of Yl 20 by
r
(Name of person acknowledging) JName of
(Signature of Notary Public- State of Florida )
M
of Notary Public- State of Florida )
Personally Known OR Produced Identification. Personally Known V"� OR
Type of Identification Produced 'IDL.- Type of Identification Produce)
Commission No. �'- mission No.
<,N Notary Public State of Florida
: Brian A Nugent
y My ommission
Revised 07/15/2014 °'aM1 �Expires 04/25/2022
1
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���, .S.�TA
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TOWKIL""
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS