HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: �° �-S" I
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
IMPROVEMENT LOCA
Address: 3
Legal Description:
c.c- `� ` a- Lot NO.—�
Tax ID #:
Black No. —
Site Plan Name:
Project Name:
Setbacks Front
Back;_ Right Side: �_ Left Side:
DETAILED DESCRIPTION OF WORK:
(.-4 lam- LLG e.r LraY•� �^. 1..�4../t+C�/
CONSTRUCTION INFORMATION:
tonawortoe ormeunethispermi-
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_ Shutters a Windows/Doors
HVAC Gas Tank ❑Gas Pi iPn g
Electric ❑ Plumbing oSprinklers
❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
S . Ft. of First Floor:
Cost of Construction: $ o Utilities: Sewer ❑ Septic Building Height:_ _
OWNER/LESSEE:
Name {~ d-�-
Address: 4�&
City: .--- state:
Zip Code: -1 7 Fax:
Phone No. e 3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: �--7 �
Company: (��z-Lx:
Address f'�
City�— ff
Stater L
:,
Zip ode: Fax:
Phone No.
State or County License: C—
if value 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: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: 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 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 Nome 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 BuildingCodes 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
commencinawr recording your Notice of Commencement.
re of Owner/ Lessee/Contractor as Agent for Owner I Sign�ffire of
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF Ar • C'Le-rC COUNTY OF "F (—
The forgoing instrument was acknowledged efore me The forggi 1g instrument was acknowledged before me
this /may of 2-�. L- J 2Q f by this P day of 7�_fr ZD_ by
# • Nahne of person matting sUtemei
Personally Known , r'OR Produced I
Type of Identification
Produced
{Signatur(of Notary Public- State cy*lorida )
Commission No � (Seal)
REVIEWS I
FRONT 1 ZONING
COUNTER REVIEW
DATE
RECEI
DATE
Rev. 8/2/17
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