HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLF INFO MOST 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 clropbox, click here
PROPOSED INPROVEMENT LOCATION:
Address:
7
Legal Description:
qq Property Tax ID #: ` -2- I Lot No.
Site Plan Name: Block No. ..-✓
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to e nerformed un er t is permit -- c ee a apply:
C HVAC OGasTank Gas Piping _ Shutters Windows/boors
ectric D Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _L"J� Q C= Utilities: Sewer E Septic Building Height:
OWNER LESSEE:
Name
CONTRACTOR:
Name• , (
Addr ^Ci
City: State
Zip Code: Fax:
Phone No. i� S�
E-Mail:
Company:
Addr-
4 r
City: �I, �� � State: f
Zip Code Fax:
Phone No.��4 #� ' -
i-
E-Mail: r�.; �, �� `6m, fta
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of
State or County License
Commencement is required.
PZM
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 JOB SATE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NONCE OF COMMENCEMENT."
Sig of Owner Lessee/Contractor as Agent for Owner
Siigria ure of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORa_
COUNTY OF -1
COUNTY OF �
The f rgoing instLwnent was ckno dge efore me
this day of 20 by
The for oing instr ent was ac nowledged�efore me
this Way of (Yl 20 by
0 -
C2, �Enco,(,? �, v, �A cxc) d
Name of person ma in state
Name of person mak ng statement.
a�R
Personally Known OR Produced
identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Nk*le
N1001e
Comm.3GG3
d
m.#GG36N75
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7
(Signature of Notary Public
ri f1JM5: N0V
(Signature of Notary Public- State Thfv Aaron
Commission No.IF
(Sea
Commission No.G. 'q-(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19