HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
CE]�1NTY �_
F L O R. E ❑ R --'�
Permit Number:
Building Permit Application
Planning and Development Services
Bull ding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential tom~
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal ;Description:
Property Tax ID M
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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C! lc. c+ T C3rl%itGn5.4--
CONSTRUCTION INFORMATION:
it ono wor to e e orme iS under permit —check a
HVAC 1:1 Gas Tank []Gas Piping
Electric ® Plumbing FISprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ •�.. -
ER/LESSEE:
Lot No.—
Block
o._Block No.
9
app y:
_ Shutters E]Windows/Doors
Generator 0 Roof Roof pitch
S Ft. of First Floor: _
Utilities:OSewer OSeptic
Address: 5l • ..� • r f
city: S -�
- State• ,��
Zip Co'cle,.3-Ll 2
Phone No.
E -Mail:
Fill in fee simple Title Halder on next page (if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
Company:
Address: -3-7
Cit `
y: . �"" r� State• i -,C.
Zip Code: Fax: 41LO L
Phone No.
E -Mail:
State or County License: CAC k ciYk 3&S -
If valvg of construction is $2500 or more, a RECORDED 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: i Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City:
Zip: Phone:
City
ZIP: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 nonresidential 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 your Notice of Commencement.
_7;�' , A��,--
Sig ature of owner/ Lessee/Contractor as Agent for owner
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -E.,c t -t f
COUNTY OF /4 - ,��.,� • .�
The forgoing instrument was acknowledged before me
this %Q day of _ "'V4 20_�5 by
ame of person making statement
Personally Known _ % OR Produced Identification
Type of Identification
Produced
of Notary P bl!S,%ftl� of Florida ]MIKE MARTIN
Commission No.
REVIEWS
DATE
RECEIVED
COMPLETED
Rev. 8/2/17
Notar Pu'¢lie - State o1 Florida
Cullon 0 FF 218951
My Comm. Expires Apr 5, 2019
W" 111`1=0 National Notary Assn.
The forgoing instrument was acknowledged before me
thisdday of _' l 20�` by
l
/�� °C. [�•� L /7 sj7
NanTe of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
ndlv.j
(Signature of Notary Publwarm''
i a) MIKE MARTIN
Otary Public • State of Flori a
Commission No. scion �► FF 216951
iN om . Expires Apr 5, 20 9
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