HomeMy WebLinkAboutBUILDING PERMITALL 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
PERMIT APPLICATION FOR
Commercial Residential
To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT _LOCATION: _
Address: y�kV[
Legal DWcription:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
tv
Back: Right Side
DETAILED DESCRIPTION OF WORK:
Left Side:
CONSTRUCTION INFORMATION:
`AdditionsI work to b rtormed un ert is permit -c ec a appy,
VAC Gas Tank Gas Piping _ Shutters
11 Electric Plumbing Sprinklers El Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 5�70
S Ft. of First Floor:
Utilities:T] Sewer 11 Septic
Lot No,
Block No.
Windows/Doors
Roof Roof pitch
Building Height:
OWNER/LESSEE: I CONTRACTOR:
Name Name:
Address: C i Company: Uti -
City: zz;C) State-V Address: r U
Zip Code:- <_�i> Fax: City�u State:0L_
Phone No. , � , GfS _ Zip Code: 67R( C) Fax��4fl_
E-Mail:__- Phone No. -NCj
Fill in fee simple Title Holder on next page ( if different i E-Mail: UW_.%
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,rs—UPPLEMEPITAL'CONSTRUCTIOW LIEN LAW INFORMATION;
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER
Name:__ _
Address:
City:
Zip: Phone:
Not ApplicaEle _MORTGAGE COMPANY
Name:
Address:
_ State: City:
_... Zip; - Phone:
Not Applicable
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.
Signature of wner/ Lessee/Co r for as A en or Owner
STATE OF FLORID
COUNTY OF '
The f ng instr en was acknowled�geqd before me
this day of-i� 2fa(5by
Name of person making statement
Personally Known ye::� OR Produced Identification
Type of Identification
Produced
Signature of ntractor/LicensHblder
STATE OF FLORI
COUNTY OF � R11 JUL
The f o ing instrum nF Was acknowledg efore me
this day of z _ y
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signaturllof NNary Public- State nP`F:orirla 1 Y 1 NivnatuU Otary Public- State of Florida) I
i
Commission f�. '
o�o�� " ,FOYc� �o �`-t2:" '`�._ ,aYcE nacw+uD-caRio
REVIEWS
DATE
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DATE
COMPLETED
Rev. 8/2/17
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