HomeMy WebLinkAboutbuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1f
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID #:
Lot
Site Plan Name: _ Block No. ^1�
Project Name:
Setbacks Front Back: Right Side: Left Side:
hptby I� k2' ft< -1d ta 0�';��, V'T
--7 -five i � sr�'�--_
ra work to a er orme under this permit — cnecK au
❑Gas
apply:
Shutters
F]Windows/Doors
VAC Gas Tank
Piping
_
Electric 0 Plumbing
0 Sprinklers
0 Generator
0 Roof C] Roof pitch
Total Sq. Ft of Construction:
�� 17 4. 0�_'
Cost of Construction: $
ScLFt. of First Floor: _
Utilities:Sewer F � Septic
Name " n
Address: (.
City: State:
Zip Code:
L
Qi Fax:��'��'""11
Phone No. -I'l -311 �h -Ta -
E -Mail:( ,' 441141171naC6 CgMC4,<iAl—"_
Fill in fe simple Title Holderonnext page ( if different
from the Owner listed above)
Name:
Company:
City:'
Zip Code: /Algs`Z
Phone No �3
E-Mail:ii i A
,4
Mir
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Building Height: _
f
State
Fax:7-7?7'3
Name:_
Address:
City: _
Zip:
Not Applicable
State:
MORTGAGE COMPANY:
Name:
Address:
City:
Phone I Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
_ Not Applicable
Not Applicable
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 to obtain financing, consult with lender or an attorney before
commencineEwork or recordine vour Notice of Commencement. /,
ntractor as Agent for Owner
Contractor/License Holder
STA+ft`OF FLORID 5JATE OF FLORID
Ay,,,
OF •L,�,I(:C COUNTY OF �j�L (�''--
The forgoing instrument was acknowledged before me The foring instr m nt was acknowledged before me
this day of20A by this �i`� day of 1 � 20 by
Name of person aking statement
Personally Known V OR Produced Identification
Type of Identification
CRAIG A.
Name of perso aking statement
Personally Known OR Produced Identification
Type of Identification
CRAIG A. GRI
MY COMMISSION FFS90902 I /� MY COMMISSION
EXPIRES I . eXPIRES Mar
(Signature of Notary Public- State f gnatu a of Notary Public- State qQ
,
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT I COUNTER ROEVI W ZNINGS REVIEWUPERVISOR I REVIEW PLANSV EVI WON SE EV EWLE M REVIEGETATIA EW
DATE
RECEIVED
COMPLETED
Rev. 8/2/17