HomeMy WebLinkAboutbuilding permitALL APPLICABLE 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:
l�`A 0 lam..
Legal Description: Q L
Property Tax ID #:�-1� BCD Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
l DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additidnal work to b rforFned under this permit — check all that apply:
r3IVAC Gas Tank Gas Piping Shutters Windows/Doors
_
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
� Y� ' Utilities: Sewer 1Septic Building Height:
Cost of Construction: $
OWNER%LESSEE:
CONTRACTOR; — ----
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Name '�
Name:
Address:
Company:
Address: 5�
city:., I r State:
City: Stater
Zip Code: Fax:
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O�S Fax:
Zip Code:
Phone No.
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E-Mail:
Phone No.�—
E-Mail:��
Fill in fee simple Title Holder on next page ( if different
State or County License: 05-3 ED-
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: _
Name:
Not Applicable
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MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
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 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 OWNE our failure to Record a Notice of Commencement may resul n your paying twice for
improvements to yo property. A Notice of Commencement must be recorde nd posted on the jobsite
before the first in ction. If you intend to obtain financing, consult with len r or an attorney before
commencing recording your Notice of Commencement. �,
Signatu
ntractoras
STATE OF FLORID!a
COUNTY OF�(k2sk
The forgoing instr ent was acknowledged before me
this 2L day of 20 oby
of) p ONJI
(Name of por son acknow4edg" )
(Signature dry PuVi
Per nalllown
T peofI
Commission No.
Revised 07/ 15/2014
Contractor/License H
STATE OF FLO I �.
COUNTY OF l
The forgoing instr ment wasacknowledge efore me
this � day of F 20 _ by
�P�1 �- Cd
(Name of pqAon acknowledgiR
catio Personally
Type.of Id(
(Seal) I Commi
of N6_ta4KPublic-
Florida )
(Seal)
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