HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J d `ZQ Permit Number:
a
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 here
PROPOSED INPROVEMENT LOCATION
Address: , Y bin _T�r
Legal Description: r 1 d I n —
Site Plan Name:
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
Block No.
CONSTRUCTION INFORMATION:
Additional wor to be oertormea under tispermit—check a apply:
1IHVAC Gas Sank ❑Gas Piping Shutt rs Q Windows/Doors
Fl�iectric Plumbing Sprinklers 2-'Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ oL , i Utilities: Sewer E Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam
Name: -'-fecX-0e"l
Address: 2__�t"n2
Company:
A
City: Hof k .— . "t __ State: �L _
Zip Code: �!f? o Fax:
Phone No, } -_ g
Address:; n ,;
City.,)6-
Zip Code����U
Phone No. L
E-Mail: CI9t
State:
Fax:
ci;l '1 t
E-Mail:
Fill in fee simple Title Molder on next page ( If different
from the Owner listed above)
State or County License
�` c_) ....' 3 X
IT value vT consirucrion Is �LWLI or more, 3 MCUKDED 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:
nWWVP/CnNITOArrrio nerim-mv.
— -- — --•- • •- -• -I I✓Y I J . iLiPP11ca11on is nereoy mace 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR Lf#DER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEM61ui_"
of Owner essee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLQRIPA STATE OF FLORIDA .
COUNTY OF v COUNTY OF
The f rg�g}ing instrument was acknowledged before me
this `fday of , 20 0 by
Name of person makin state
Personally Known OR Produced Identification
Type of Identification
Produced
McMl
{signature of Notary Public rift hs: Nov. ,
FCommission No.C�i�i ���� lf—ll
REVIEWS I CO FRONT TER � REVIEW ZONING S REVIEWOR
RECEIVED
DATE
COMPLETED
The rgoing instrument was acknowledged before me
thi 'Yl day of f6i�C� 200 by
Name of person mak ng statement.
Personally Known OR Produced Identification
Type of Identification
Produced
Nicole McMf
COMMAGn
(Signature of Notary Public- StatelAMOA
Commission No. �; ' (Seal)
PLANS VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW