HomeMy WebLinkAboutBuilding Permit ApplicaitonALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: it & q __ Permit Number:
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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 line7
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:.
Property Tax ID #: c.)1r D(4o. — C Lot No.
Site Plan Name: Block No.
Project Name: r.L1441f1 50ilZ
Setbacks Front Back: Right Side: Left Side:
rDETAILED DESCRIPTION OF WORK: _ 4
1311 �, � /0r� �ss�
CONSTR CTION INFORMATION: J
!ii a work to be nertormea un er this permit – check all apply:
IV
HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
11 Electric LJ Plumbing 11 Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq, Ft. of First Floor:
Cost of Construction: $45"299Utilities: Sewer !_J Septic
Building Height:
OWNER/LESSEE: 'CONTRACTOR:
Name � – Name: i e
AddreS :+ Company:
+� y
City: State: +� Addr ss: D
Zip Code: + Fax: City: U Stater
Phone No, Zip Code: U Fax.. -Tv- ;L'
E -Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E -Mail: ,vv S.G'
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
_ Not Applicable MORTGAGE COMPANY:
Name:
Address:
State: _ City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City: �-
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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, 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 recordin our Notice of Commencement.
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Signature of caner/ Lessee/Co r for as A(eqfor Owner
STATE OF FLORIDj
COUNTY OF� 010 ['\
The f rQoing instru t was cknowledg�fore me
this day of�2 by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signaturl# of Nbtary Public- Staa-tp. nT`Floriri;1 I
Commission �..V ll
REVIEWS FRONT ZONING
COUNTER REVIEW
I DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Signature of ritractor/Licensf H Ider
STATE OF FLORID
COUNTY OF MZ► Qrtf_
The Fof Qoing inst„rumer t as acknowledge efore me
this 1-- day of _ 20by
Name of person making statement
Personally Known L=f!OR Produced Identification
Type of Identification
Produced
1Cianatu$,4f 1g8tary Public- State of Florida )
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�S:�► 25.2022 ' +r eg° EXPIRES: Apn125, 2022
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SUPERVISOR I PLANS VEGETATION I
REVIEW I REVIEW REVIEW