HomeMy WebLinkAboutbuilding permitALL APPLICABLEINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: } 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 arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
N--4 �-AAo3fil
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Property Tax ID #:
Site Plan Name:
Project Name: —
Setbacks Front
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Back- ... Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
c Tiona work to be ertormed under this perm: - check 811 apply:
C�HVAC Gas Tank ❑Gas Piping _ Shutters
Electric ❑ Plumbing Sprinklers Generator
Total Sq. Ft of Construction: _ Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer 11 Septic
OWNERAESSEE:
Name i i
Addrreesss,
City. \ r State:
Zip Code: "1 . Fax:
--
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
I CONTRACTOR:
Name:
Company
Address:
City:
Zip Code: Z U
Phone N .
I E-Mail: L
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Lot No./53
Block No.
❑ Windows/Doors
DRoof Roof pitch
Building Height:
SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: _
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City: T
Zip: Phone:_
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
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 our Notice of Commencement,
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Signature of wner/ Lessee/CI
rAtorasA & or Owner Signature of ntractor/Licens H Ider
STATE OF FLORIDA STATE OF FLORICLA
COUNTY OF� COUNTY OF_ j eg=
The fo oing instrum nt as acknowledged efore me The ;Ding insUXum nt as acknowledge efore me
this day of
2( this day of � 2QGby
Name of person making statement Name of person making statement
Personally Known S/ OR Produced Identification Personally Known FOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatur of N 'Na Public- State n ioriH;; I ICianatu f tary Public- State of Florida )
Commission `�L Q &L-) '"` JOYCE 1rSICHAO ; fs�'°` ; ; JOYCE M WIJD-CARLO
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REVIEWS FRONT ZONING SUPERVISOR PLANS I VEGETATION
COUNTER REVIEW REVIEW REVIEW ' REVIEW
DATE ~
RECEIVED
DATE
COMPLETED
Rev. 8/2/17