HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
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Address: ,.,. ��^^i 1/
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Legal Description: � ' •� � � � /4 �!
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Property Tax iD #: L `J `-1 Lot No. b� 2�
Site Plan Name: CM JL „ „ _ �. Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to flasTank
orme under tispermit—checka apply:
C�HVAC Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ `T, Lf
Sq. R. of First Floor: _
Utilities: Ll Sewer ElSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
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Name:
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Address
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Company:
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City: ate _ St:
Zip Code: Fax:
Phone No.
Address:
City:
Zip Code:
Phone No.
�� 1 Stater'
f' Fax:
77� 7 Lf.SJ
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: `7i1�5
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERJENGINEER: _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:
a wu IV L-nl ..vim I F%M%- i un /Arritivit 1 : 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 Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, € 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 ' yaur paying twice for
improvements to yo Pproperty. otice of Commencement must be recorded anld poste the jobsite
before the first inspection. If you in end to obtain financing, consul 0�yth lend& or an at erne before
commencing worA or recordine you Notice of Commpnrprrrlpni 1 / 1 1
/ I
1
Signature of O ner/ Lessee/Contractor a Age! t for Owner
Signature of Con�'r�ctor/License Ho der
STATE OF F 6RIDA
STATE OF FLORIDA
COUNTY O
COUNTYOF4
The forgoing instr m�ne�r��t__was acknowledged efore me
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The fo ping , stru ent yeas acknowledged -before me
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this da of 20 l_by
this of � 20�y
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Name of person making statement
Name of person making statement
Personally Known ,c_ OR Produced Ident' c tion
Personally Known . k OR Produced Identificati
Type of identification
Type of Identification
Produced
Produced <
( ignature of N ary Public-Sta e of FI
Signature of Nota u I'c-S a f I r"
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~bus 04V Expires 0512812020
Gov �p� Expires 0512812020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17