HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:! I o Permit Number:
Building Permit Application
Planning and Development Services "
Building and Cade 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: V l'V
Legal Description: ( COU L
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
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('CONSTRUCTION INFORMATION: I
LVJHVAC L { Gas Tank UGas Piping "Shutters
11 Electric 0 Plumbing nSprinl
Total Sq. Ft of Construction(, A
Cost of Construction: $ " O • DQ
ers a Generator
S �Ftj. of First Floor: _
Utilities:) _ISewerElSeptic
QWindows/Doors
EIRoof
Building Height:
OWNER/LESSEE
CONTRACTOR:
Name ei Is-pil kaku
Name:
Addre�ss�t �Cl�`CliVlO
Company: V(Q,
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City: ) Ur uy �Itftp Stater
Zip Code: 3 445_ Fax"
PhoneNo.lal- S31--0111fB0
Address:3lt% TUPYI�if(G2 �P�fCLt
City: fb(b I fefc&
Zip Code: '3 5
Phone No.-" A-
State: R_
Fax: -772--4&(e-373'I
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:6A\ll Pau ga
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State or County Licenfe:
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If value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
OWNER/ CONTRACCOR AFFIDYIT: 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 Rome Owners Association rules, bylaws or aril covenants that may, restrict or prohibit such
structure. Please consult with your Rome 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 wi 1, 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 morns 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
commencingwork or recordingour Notice of Commencement.
Signature o€Owner{ lessee( tractor Agent for corer
Signature of Contractor/License
Rev. Sj2/17
SUPPLEMENTAL CONSTRUCTION LIEN LAW ifdFUFtMATIE}1V:
DESIGNER{EN6lNEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
�=
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City;
Zip: Phone:
Zip: Phone:
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