HomeMy WebLinkAboutBuilding permit applicationALL APPLL�I B E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` Permit Number:
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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:
Address: U!zLQ _ 1, �1 %-
Legal Description:
Gylr`1 ��rti� '`•l �1�
Property Tax ID #:
Site Plan Name: ��{ L4
Project Name:
Lot N
Block No.
Setbacks Front Back: Right Side: Left Side:
LDETAILED DESCRIPTION OF WORK:
C4
Cr" 4
CONSTRUCTION INFORMATION:
Acid itiona I work to e e orme un er t is permit --ch ec a appy:
1JHVAC 13 Gas Tank E]Gas Piping _ Shutters �lindows/Doors
11 Electric LJ Plumbing Sprinklers Generator L=1 Roof Root pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities:� Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Addre,sk
Company: 5
Addr ss:
4
City: State: 1�1--
Zip Code: Fax:
City State: �_
Phone No e -
Zip Code: Fax:
E -Mail:
Phone No. w c r
E -Mail:
Fill in fee simple T14e Holder on next page ( if different
from the Owner listed above)
State or County License:
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTi�N LIEN LAW INFORMATION:
DESIGNER/ENGINEER Not Applicable
Name:
Address:
City: State:
Zip; Phone:
FEE SIMPLE TITLE HOLDER: Nc�t Applicable
Name:
Address:
City:
Zip= Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip Phone=
f3ONDfNG COMPANY:
Name:
Address;
City:
zip= Phone:
I certiFy that no work or Installation has commenced pno; ,o the issuance of a permit -
Not Applicable
State:
Applicable
St. Luce County rnal _ns no representation th6t is granting a permit Will au_horize thepermit ho der to build the subject Structure
which is in corflict ,r�ith any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structu e. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of ,he granting of this requested permit, I ec hereby agree that! will, in all respects, perform the work
in accordance with the approved plans, the Florida Buiiding Codas and St. Lurie County Amendments.
The foilOwing building permit appll"cations are exempt from undergoing a full concurrency review: roorn additions,
accessory str uMres, swimming pools, Fences, wails, 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 twicefor
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the firs:- inspection. If you intend to obtain financing, consultwith lender or an attorney before
commencing work or recordin&_your Notice of Commencement.
r, r�jf
nature of O'rynerjLcssee�contra�:or as Agent for v'
Cat her i T -r -at ur e at Contractor! Lice nSe Holder
STATE OF FLORIDA �COLJNTYOF
STAT E OF FLORIDA
COUNTYOF �i.�.-> ,n VKck-1,-44,._
The forgo.na instrurnent',vas ack nov., !edged befere me I The forgoing i,sti`Umicnl was acknowiedged before me
th fs ' dp 10' —� ____' 20 t .,- d i Ji:t9ti7 ❑a IV OF (ta ,^ C/E . 20 W V b] j
l S +.E of e_ 91-11. i.A—
f Name or' person acknotaledging j t name of person acknowledging I
- A /—I A-- A , Z�� —
f5ignatur o= Notary Puhiic-State of Fiorida) ,S_ignaftrlre of notary Public- State of Florida)
Personally Kno pe Produced identification I ?ersonaily Known OR Produced Identification
Type of ider,tif ..atlon Produced Type of Identifit ion Produced
s
Commission No. Corr:mission Ne. _
,aY NICOLE RATTON "ter u,,, NIC LE FATTON
State of F}orida-Notary Public ?2' _State of Florida Notary Publ
c'i1SC i 'NJ M cornmi -
geao ce�A y ssinn Expires ' ...... it+4y commission Expires �L"dirty May 07, 2022 '" 5` May 07, 2022p
REViEWS
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