HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE
I IFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
_ u
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 2,1� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
1 PROPOSED[[ IMPROVEMENT LOCATION: _ �_-
Address:
Legal Desc iption: �� L (2) (�
Vu w
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I CONSTRUCTION INFORMATION:
�Ait+❑ wor to e erforme under this perms -check all apply: -
FIVAC Gas Tank Gas Piping _ Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator L 1 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: _
Cost of Construction: $ 7A Utilities:11 Sewer 0 Septic Building Height:
OW ER/LESSEE: CONTRACTOR:
Name 7 Name: _
Address: I Company:
City: rr State: _ A dress: ��"l, — '•Z.
Zip Code; l Fax: City. rIJ 4 - State:
Phone No``� Zip Code: Fax:
E-Mail: _ _ Phone No.]•
Fill in fee simple Title Holder on next page ( if different E-MailRtll
from the Owner listed above) State or Count License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
�n
rSUP PLEMENTAL`CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip; Phone:
Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:__
Address-
City:
Zip: Phone:
BONDING COMPANY:
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.
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 applfcable 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 recording our Notice of Commencement.
Signature of wner/ Lessee/Cot
essee/Co r for as Aenyor Owner
STATE OF FLORID �,
COUNTY OF`j�!]��f
The fgWoing instr.0 e t was acknowledge�by
efore me
this /�( day of MU 2(7
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
- AAQ9/��
Signature of dbntractor/L€cens HbIder
STATE OF FLORI
COUNTY OF_` L4v.Zt,
The f Ing instCu enr as acknowledg efore me
this t=� day of ZOby
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signatur of N tary Public -State n ,loriria 1 1eionatu tary Public -State of Florida )
Commission tf.. � ��f qA' Joyce MICK404 J OYCE
r? ''' 6vnded Ttru Putfc 28�2p j* _ AK
ryMUD-CAL0
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION I
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE _T
RECEIVED
DATE --
COMPLETED
Rev. 8/2/17