HomeMy WebLinkAboutPermit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
s
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
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIO --N OF WORK:
CONSTRU N INFORMATION:
A ition work to En
orme un er t is permit - c ec a appy:
VAC Gas Tank E]Gas Piping _ Shutters Q Windows/Doors
Electric 1:1 Plumbing Sprinklers Generator Ll Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ r`C`
S.Ft.. of First Floor: _
Utilities: L_I Sewer 1:1 Septic
OWNER/LESSEE.: I CONTRACTOR:
Name k
Address:
City: -- State:
Zip Code: Fax:
Phone Na�7k� ���_ cx(n?D G --I
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name:
Company:
Address: C L
City: State:
Zip Cod _'�DL\AL Fax:
Phone No. �— 2Dq
E -Mail: 0
State or County License: -
ii vame UT consiruciion is �)CSuu or more, a KECUKDED 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:
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
commencing work or rcling your Notice of Commencement.
_ Signature of Owner/
ignature
er
STATE OF FLORIDASTATE OF FLORIDA
S\L\�LL COUNTY OFLo-, _ COUNTY OFx\
The forgoing instru ent s acknowledged before me
this day of 20 4by
(Nam of person acknowledging )
i I
( igna ure of Notary ublic- State of Florida )
Personally Known OR Produced Iden ifita i n
Type of Identification Produced''
The forgoing instrupient was acknowledged before me
this � day of 20 —_I— by
V\ �\_ cry
(Name f person acknowledgingR)
( ignature of Notary Public- State of Florida }
Pers n IJ nown- OR v
3 � _ d tificat- n Produce ,y,_ M�tAr. Pubm Sete of FWK3a
Commission Na. C 1 tl �: Wanda E Mer o
LY) Wanda E Owca oMy curnnssm r ClOdMlf8i5si No.%miseiGG 1381;s
w Expires GOrM202 0812012021
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION SETA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS