HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: — Permit Number:
.wW
' 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: Iff At
Legal Description:
Property Tax ID #: - Lot No,
Site Plan Name: Block No.
Project Name:1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: AA-
[6—adL - - -
)w t1141e ()Lr�
[CONSTRUCTION INFORMATION:
itton wor to e e orme un er this permit — c ec a appy:
VAC Gas Tank DGas Piping Shutters Q Windows/Doors
_
11 Electric 1:1 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ �( �{p-� Utilities: Sewer L vJ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name _ Name:
Addre ►I��fI Company: 3
City: State: Address: ilk"
Zip Code: Fax: City: ry6 State:
,rte
Phone No.%. Zip Code: 1A4e0 Fax-- -24 � TI
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different + E-Mail u SLWC4S.6f1J:
from the Owner listed above) State or County icense: OAC t5S-7 r#
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL "CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phone
Not Applicable-
State
MORTGAGE COMPANY
Name:
Address:
City:
Zip:. Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
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.
5t. 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 biome 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
co,mmencing work or recording our Notice of Commencement.
Signature of wrier/ Lessee/Co raftor as A en or Owner
STATE OF FLORID
COUNTY OF '
Thef9�{eoing instru ent was acknowledged before me
this C7� day of � � 201 dTby
Name of person making statement
Personally Known %,t.rA OR Produced Identification
Type of Identification
Produced
(Signaturl� of Notary Public- State i?'Flor1H;; 1
Commission
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
Signatu4ofntr`actor/Licens/41der���
STATE OF FLORIQA
COUNTY OF
The f rgoing instc t was acknowledgPbefore me
this day of 2 by
Name of person making statement
Personally Known _J,!�OR Produced Identification
Type of Identification
Produced
ry Public -State of Florida )
JOYCE�l��C
MY OMISSION 0 00 2N220
. DSM. APd 25.2022
SUPERVISOR PLANS VEGETATION I
REVIEW REVIEW REVIEW i
DATE
COMPLETED �L
Rev. 8/2/17
JOYCE AII`"UD-M4
MYCOM4149" # 13G 284220
OSRES;APd 25, 2022
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