HomeMy WebLinkAboutBuilding Permit Applicationt �1
All APPLICABLE INFO 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:
Address:
Legal Description:
i
I
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Well
Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
i
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:_
Cost of Construction: $ Utilities: _ Sewer _ Septic
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D
Lot No.
Block No.
�ndows/Doors .
Roof Pitch
Building Height:
OIN{NER/LESS
CO'NT ACT®R:
Name 1 s
Name: )171
Address:' e ®c'
Company: G
_
Address: %�n / �' jam; Pz��L
City: s U �- State-F
Zip Code: Fax:
City: pr9X%ST L(ia'e Stater
'Phone No. 7 —
Zip Code: 3U 2-� 3 Fax:
PhoneNo 2 00—
E-Mail:
;Fill in fee simple title Holder on next page ( if different
E-Mail
;from the Owner listed above)
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State or County License ?.iO'2-
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU'PPLEME
AL CONSTR.t7CT10N LIEN LA1A INANORMATIO
DESIGNER/ENGINEER: _ Not Applicable
Name: -
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:..-._
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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, consul with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
o C ntractor/L se Holder
STATE OF FLORIDA
ft
STATE OF FLORIDA�
COUNTY OF
COUNTY OF
The forgoing instr nt was acknowledg before me
�.
The f going instru ent was acknowledge before me
this A& day of 207§ by
this day of 204L by
fY-\�\ Q r r 0"'
En-t ( QaXro.n
(Name of person acknowledging)
(Name of person acknowledging)
Ik k, "I WA )m
(' at re of Notary Public- to of Florida)
(' na ure of Notary PUR4 State of Flori )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No.. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014