HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABI V 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P,
M,'' 110: N, t
Address:
Legal Description:
Im
Property Tax lD #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTION
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WINFORMADON:
Additional work to be oertormed under this permif::� check all t= apply:
0HVAC Gas Tank [--]Gas Piping Li Shutters Q Windows/Doors
IJ Electric 0— Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SQ. Ft. of First([
irst Floor:
Cost of Construction: $ 1 Utilities: 0 Sewer []Septic Building Height:
OWNER/LESSEE:
CONTRACTOR,
Name
Name: (vio.,fe-t-
E iQ,y,9_rQ Tie_'Vf u aibe4,
Address: 101e55 (1100 QCompany:
City: Eex-64, state:
Address: 155-7 S� GwtP) 1), emem-e-c dic e-
.1
City: e State:
Zip Code: 3q9 L457 — Fax:
Phone No. 213v 1010
Zip Code: _3 q Fax:
E -Mail:
Phone No. :1 -72-3 -37 -32:2 -
Fill in fee simple Title Holder on next page (if different
E-Mail:4&, ia(00
from the Owner listed above)
State or County License: 2!12_56o
if value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
0 •. W
h nor. -m
DESIGNER/ENGINEER; _ Not Applicable MORTGAGE COMPANY: � Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: lNot 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, 1 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 accessary uses to another non-residential use
WARNING TO OWNER- Your failure to Record a Notice of Commencement may result in your paging 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
commencing wwk or recording our Notice of Commencement., e ',
Signature of Owner/ Agent/ L ee/Contractor
SigKsatu e of dontractor icense 0older
NATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF 1 �a tai
The forgoing instr e t was acknowledged before me
l ii day v' 2,Q.(. by
The forgoing instr went was acknowledged before me
this I I day of 'r i Ct`l-i V2D by
this of ,
(Name of person acknowledging)
(Name of person acknowledging)
t
(Signature of Notary Public- State of Florida }
(Signature of Notary Public- State of Florida )
Personally Known
Personally Know g OR Produced identification
Type of identificati ;��A6�HAEldIiFiAR
Type of ldentific tiq'•"
_60.. �IC99�4�L �IERlIi�R
Produced .: :R= MY COMMISSION n FF230846
EXPIRES May 14. 2019
Produced .� � 4 MISSION # FF23oa46
Commission No. ' ' `" =1 PhaxtaN .ecw.
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l..ommiSSiarl-Na. EXP3RES Ma*i9
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
DATE
RECE#VEf�
DATE
T17==]
COMPLETED
Rev. a