HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICA LE IJYFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f 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
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: l�)lD ` e
Site Plan Name:
Project Name:
Setbacks Front Back:
-ErrC'i�
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
/Adanrtiona war to e e arme un er t rs permit— c ec a appy;
OHVAC LJ Gas Tank ❑Gas
Piping11
_Shutters
Electric 1:1Plumbing Sprinklers
Generator
Total Sq. Ft of Construction:
Sq. L. of First Floor:
Cost of Construction: $ ] � Utilities:
Ll F�
Sewer Septic
OWNERAESSEE:
CONTRACTOR:
Name ! MVRIOT'
Name:
Address:O� - Y 11�--
Company: T
�7
City: C--P-State:
Address;
Zip Code: Fax:
City:c I afuo
Phone No.—21-2— A� f Cl ` „0 62 / _
Zip Code:
E -Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E -Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Lot No.
Block No.
L_I Windows/Doors
F]Roof Roof pitch
Building Height:
Fax:
r
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name: Not Applicable
Address: Name:
City: Address:
State:
Zip:Phone Zip: Phone: State:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY:
Name: — `Not Applicable
Address: Name:
City: Address:
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 priorto the issuance of a permit.
wh ch is inocnflict with any applicable Home oat wners AsssociatFn rulesabylaws or and covenants that build
ay restrict or pr Mbit 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 resu 'n your paying twice for
improvements toy r roperty. otice of Commencement must be recorde poste the jobsite
before the first ins ection. If u in end to obtain financing, consu th len r oan an at me before
commencing work or r�corcWhgyour Notice of Commencement. %
Signature of
STATE OF
COUNTY 1
for Owner I Signature
The forg ng Instrum t was ack nowledge efore me
this Ma a Y 20 by
Name of person making statement
Personally Known y:- OR Produced Ident' c tion
Type of Identification
Produced
f
( ignature of N ary Public- 5 a of FI 1
Commission o�o41"�q-iiccab()F
ooNottary,Public State sww
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ni�t
a
y F 981647Expires 0512812020
REVIEWS �FRONT ZONING
COUNTER REVIEW
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PLETED
Rev. 8/2/17
STATE OF Ft
COUNTY OF
TheDingA0,
this �Z
er
was a knowledg efore me
,, 2i)t by
Name of person making statement
Personally Known fir: OR Produced Identificati
Type of Identification
Produced
Signature of Nota I"c-
Comml55fo �ti a4a! Notary Public State of F,IQrid�
ak�oni (� ea
My Commission FF 981647
os�4� Expires 05/28/2020
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