HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO )MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED % /
Date: �/' / % ` Permit NumbeF
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---- Building Permit Application NOV - 8 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. LLlcie Count
2300 Virginia Avenue, Fort Pierce FL 34982 / y, FL
Phone: (772) 462=1553 Fax: (772) 462-1578 Commercial Residentia
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEK49NT,LOCATION--` =M
Address:
Legal Description:
Property Tax ID #: 5WLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be ertormed under this permit— check all apply:
CJHVAC G s Tank ❑Gas Piping M_ Shutters Windows/Doors
Electric Lr J Plumbing Sprinklers ❑ Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ �� IQ� (�(� Utilities. _Sewer ❑Septic Building Height:
OWNER/LESSEE :
_CONTRACTOR:
Name
Name:
Addre s:
City: p St e:
Zip Code: 8 Fax:.
Phone No. �
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company:
AddreV-eil'
City:
Zip Code:
Phone No. —
State:��'�
Fax: 7 i
E-Mail:
State or County License:
-70
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION. LIEN:LAW'INFORMATION.,
DESIGNER/ENGINEER: _ 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:
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 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 your Notice of Commencement.
Signature
r as Agent for Owner I Signature orContractor/Lic4se Holder
STATE OF FLORIDAJ STATE OF FLOTrLue�_l
COUNTY OF.l 6 LAL'dl COUNTY OF
The forgoing instr
ent was acknowledged before me
The forgoing inst ment was acknowledged before me
this � day of
cr 20 J# by
this _ day of i1 1 20$ by
of
person making statement
Name of person mak' g statement
sonall Know
OR Produced Identification
P rsonally n OR Produced Identification
Type of Identification
Type o dentification
Produce
Produc
(Signature of No
ignat re of Notary - ate of Florida )
Commission'No.
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Commission No. S.
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bonded Thru Notary Public undenaitms
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17