HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number:
i
4 !
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 TYPE: Live, �UY Lc lu Alc �eplactweo�
PRD.POS;ED� INPROVEM ENT LQCATfON=:
..
Address.: . 9 I�� K 1Y- T
Property Tax ID #: �Z24 5C) Z - W SS - Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK.
0 fin,�r
ItONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
ZMechanical _ Gas Tank Gas Piping Shutters _ Windows/Doors
Electric Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ J Utilities: —Sewer _Septic Building Height:
.OWNER/LESSEE:
..Name
CONTRACTOR:
�-- -� i eJK al A
Name: C ` '
Address: �Y11►
Co mpany i) rt 0t U
City: �L"��J-i ILL State: �
Address: ��'� ,t 1
Zip Code: Fax:
CitStater
Phone No. " '
Zip Cod L 0 Fax:
E -Mail:
Phone No' �- Q� 2�a
Fill in fee simple Title Holder on next page ( if different
E -Mail
from the Owner listed above)
State or County Li�`enseC &--.� D tJ `-Y j fl
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required,
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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Not
Name:
Address:
City: State:
Zip: Phone:
PEE SIMPLE TITLE HOLDER:
Name: _
Address:
City►:
Zip: Phone:
Not Applicable
MORTGAGE COMPANY, �. Not Applicable
Name:
Address:
City: State.
Zip:Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone,•
I certify that no work or Installation has commenced prior to the issuance of a permit,
St, Lucie Counter 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 Horne 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 1 wlll, 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 1 e first ins action, If you intend to obtain financing, consu n attorney before
co enc! r or recoramg-yQrur Notice of Commencerne
5lgitature of"Owner/ Lessee/Agent,
STATE OF FLO IRA
COUNTY OF
t: Wh s
The f r oing Instru ent was acknowledged before r
this day of 20 If1by p,
tS2
person
of Notary Public -
Personally Known t_' OR Produced identification
Type of Identification Produced
Commission No.';� . -7(Seal)
Revised 07/15/2014
Signature
STATE OF FLOR r r� �' Z!,COUNTY OF � - L`�, � I"=
The forgoing instrument was acknowledged before m ,
this �!Z day of Jvq20 by
Personally Known !,. OR Produced Identification
Type of Identification Praduced
Commission Na.7 t (seal)
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