HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLI gl
FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: "1 8 Permit Number:
Building Permit Application
Planning and Development
ion Dices
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 III
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal
Property Tax ID #: IW6101-D 000 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
UIQ FOr U6: J—Mzu new t, m,ox 3.5 -tali, 15 se,6c Rei
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CONST LICTION INFORMATION:
tt na workto e e Orme under this permit --check a
appy:
Add
Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 5100-00
S Ft. of First Floor: _
Utilities: Sewer ❑ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: 1
Address: (LI
Company:
City: 6)ft N L((Qi State: R-
Zip Code: ISO W Fax ' R)`k
Phone No. 1a: fZgb 359
Address:J
JIB rx
City: /)rffQ &
Zip Code:
Phone t�o.77,2 -4(0� -
State: q,
FaxIl2-f —b(P-- 3133 1—
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E-Mail:IJ4 A
Fill in feesimple Title Holder on next page (if different
from the Owner listed above)
E -Mail: V�QQLk
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State or Co�hnty Licens :
CAC t$1313(1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
Qty:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: —Not Applicable
Address:
Zip: Phone:
1 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 andcovenantsthat 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 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
mmmencine work or recording your Notice of Commencement.
Signature of Own Agent{ see
STATE OF FLORIDA �
COUNTY OF Wil l
The for Ding in ment w�s ac owledged before me
this day off 20 by
1�
(Name of person acknowledging )
(Signature of Nota ublic-State of Florida)
Personally Known -�—/ OR Produced Identification
Type of Identification Produced
Commission o`.o°"• CHRISTINE Jt5S1: ELL
�,-ttdiary'Public-BFag�Florida
Commission M GG 017839
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Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing in ment was acknowledged before me
this dayo%J PAS •.20_1�rby Clt,)
(Name of person acknowledging ) -
(Signature of Notary, /blit- State of Florida }
Personally Known V OR Produced Identification
Type of identification Produced
Commission
Notary Public - State of Florida
My Comm. Expires Aug 21, 2020
a,odad rhrouah National NOINY Assn.
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