HomeMy WebLinkAboutPERMIT APPLICATIONAll APPLICA LE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C Permit Number:
-I J
•
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
PERM IT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: � ?
A
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
;7Mechanical T Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ C) G Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name ♦
Name: '� i d
Address: G `C`
Company: �-
City: VAC State:
Addr ss: C ` t
Zip Code: L Fax:
.\ 1 Sta e:4[L
City: NP
Phone No. -_�L -�.�
Zip Cod : Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail c j
from the Owner listed above)
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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 wprk ording vour Notice of Commencement-
- Signatu"re oYOwner
rise Holder
STATE OF FLORIDA , I STATE OF FLORID{ �—
COUNTY OF COUNTY OF
\�
The forgoing inst m nt was acknowledged before me
this _A� day of 20 ]-by
Cyr' rs
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identificat• Produc
Commission No,
Revised 07/15/2014
On E Mercado
VM �Hmmission GG 136118
Expires 00120/2021
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
The forgoing instrum nt as acknowledged before me
this day of 20 J� by
(Name of person acknowledging)'
k A ok
{Signature of Notary Public- State of Florida )
Personally Known OR Produced identification
"be of Identification Produc • `ti' fir•
Notary Public Style .., "WV
Commission Not L Y` mis4ionGi3 s lA1
Expires o8r2or2n2'
SUPERVISOR PLANS VEGETATION � SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW