HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE C07PLETED F461P 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 v/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEQ IMPROVEMENT LOCATION:
Address:
Legal Description.
CLn -.,I -
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
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2. TEN 1 - 5f fn I 1
(If a Ct (-A fi-
CO STR CTION INFORMATION:
itio a w ork—to-begertormed under this permit—check all thatapply:
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VAC _Gas Tank ❑Gas Piping _ hutters F]Windows/Doors
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11 Electric Plumbing Sprinklers Generator 0 Roof Roof pitch
Total S4•Ft of Constructi S Ft.of First Floor:
Cost of Construction:$� Utilities: Sewer CI Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Nam Name:
Addr s: Company:
City; Stag Addre s:
i
Zip Code: Fax: Cit State:
Phone No �C 3�_' 7J U U -1 Zip Code: Fax.
E-Mail: Phone No.
Fill in fee simple Title Holder on next page I if different E-Ma :
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: 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:
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 you intend t obtain financing, consult with lender or an attorney before
commencin word., recording yo r c8 of Commencement.
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Signature of Owner/Les /Co ractor as Agent for Owner Signature of C-ontracto-r/LialfriHolder
F
STATE OF FLORIDA (� STATE OF FLORIDA n ,
COUNTY OF f C I�� 1 V COUNTY OF I�/�
The ing instr r}t-�'1� d before me The �K iris u wledg efore me
this day of J�k��.�-l.rr2 by this0..�iay of � i ,ZO
r � I r
Name of Ter n making st tement Name of p rs maki g statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
V')
(Signature of No ary Pu i tate o Fior' a-) {Signature of Notar Public f f ri a
Commission No.4 ' tbeal) Commission NF� (Se I)
REVIEWS F My C"RAION OR PLANS ' by �l�l�t9 MARIE CR zADO ROVE
FF
CE3.0 ' R WpQfWune 5,"IE REVIEW E PIAC��'("25 EW
DATE - _� 3 0— __ _.. Florld�Nah
RECEIVED
DATE .._._....._......._.......---
COMPLETED
Rev.8/2/17