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 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address
Legal Des
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
Lot No.
Block No.
CONSTRUCTION INFORMATION:
-itionaTwor to (ne ormea under this permit- cHeck aICappry:
HVAC LI Gas Tank F]Gas Piping -n-_ Shutters a Windows/Doors
Electric ❑ Plumbing ❑ Sprinklers 1:1 Generator E]Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor: _
�.�CR<i�
Cost of Construction: $ � (1 Utilities: _ Sewer 11 Septic
Building Height:
OWNERf LESSEE:
CONTRACTOR:
Name ��l(,
Name:
Address: -1 i
Company:
Address: Y3U Irmk)
J J
City: ! � v State:
Zip Code: L Fax:
City: 'L 4-*� �.t �—Q
State: _
Phone No. �1 ��u"
Zip Code:
Fax:
E -Mail:
C3
Phone No/.
Fill in fee simple Title Holder on next page ( if different
E -Mail:
State or County License:
`�. }ir �}C��� a,
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
SUPERVISOR
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
SEA TURTLE
Address:
City:
Zip:
State:
Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
REVIEW
BONDING
Name:
Address:
City:
COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
Zip:
Phone:
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 thepermit 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 woxk or recording your Notice of Commencement. ,
s
Signature of Own Lessee/Contractor as Agent for Owner Signature -off ntractor/License Holder
STATE OF FLORIDA , STATE OF FLORIDA; )
COUNTY OF e I,J OC� COUNTY OFI
The f r oing instrument as acknowledged before me
this( day of C1 �� 1 20 ,1by
(Name of person ac
(Signature of Notary Public- State of Flori
Personally Known OR Prod
Tvoe-of Identification Pr __�euei
• av'vuej• 1�Alnn10111�GGy��._
Commission N ommiss ovemba��ao�'syTo�s
«: <` ExPues iroVFaiolt�sute
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Revised 07/1
The forgoing instrumenj was acknowledged before me
this,'—ki day of T� 1 20 v)( by
(Name of person acknowledging--) /
A /
(Signatufe of Notary(P-ub ic- State of Florida )
,PeFonally Known OR Produced Identification
Type of Identification Produced
-- _ _ ra.rrw+—I
Commission No.KATHgYN ROSENI)
commission # GG 920415
Bonded Thru Troy Fain Insurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS