HomeMy WebLinkAboutBuilding PermitALL APPIILICA LE 1NF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I c 21 �+ Permit Number:
40 -
Planning and Development Services Building Permit Application
Building and Code 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 here
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description:llt() '
�PropertyTax]D�#-Lot No,
Site Plan Name: Block N
Project Name:
Setbacks Front Back. Right Side: — - Left Side:
DETAILED DESCRIPTION OF WORK:
1 �
CONSTRUCTION INFORMATION:
111:1,131itill: ona wor to e 106 orme un ert is permit—c ec a appy:
�HVAC Gas Tank Gas Piping _Shutters
ectric Plumbing Sprinklers Generator
Total Sq. Ft of Construction: S . FtFt.j of First Floor:
Cost of Construction: $ Utilities: u Sewer Septic
OWNER/LESSEE: CONTRACTOR:
Names Name: i
Addr S:_: 42� Company:
City: State. Addrfess:'
Zip Code:. ax:
city:
Phone No. Zip Code`3Z
1-Mail: Phone No.�,_____
Fill in fee simple Title Holder on next page { if different E-Mail: a
from the Owner listed above) State or County Lice
If value of construction is $2500 or more, a R�CORpED Natice of Commencement is requlred.
Windows/Doors
Roof
-------------
Building Height:
Stater
Fax:
177
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City State
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
____ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City State:
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 work or recording our Notice of Commencement,
Signature of Owner/ Lessee/Agent
STATE OF FLORID v ,l I STATE OF FLORI
COUNTY OF COUNTY OF
The forgoing instr a aas`a o ledged before me The for g Instr as ckno edged before me
this day of 1 20 $by this for
of��2p b
men � �`-- y
farOrind(3ionrw 0. dr, nA' .21 T
Name of
of Notary Public- State of Florida )
.1k .Z 3 1 (Name of
of Nota't`y PL%Iic- State of Florida)
PersonallyKnown �oR Produced Identificati `,`i�r'"'.,, y i/ OR Produced Identification �11Y1�.
a Personally Known `''�i•'�. IN
IN of Identification Produced =� = Type of Identification Produced_. ;d?
. (Seal)
)�r:u „►`' Commission No. (Seal)
Commission No
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
COMPLETE
INITIALS