HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:
J
•
X111
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 L CATION;
Address: W _ - -- --- -
Legal Description:
Property Tax ID #:
Site Plan Name: _
Project Name: —
Setbacks Front
Back: _ Right Side: _ Left Side:
Lot No. CK
I 45i
Block No.
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additionafwork to!e]erformeaunder is permit- check a appy:"--
HVAC Gas Tank EGas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
toCost of Construction: $
OWNER/LESSEE:
Sq. Ft. of First Floor: _
Utilities: Sewer Ij��J Septic
Name
"UL
Address-
0
City;
StateA=
Zip Code:
Nw Fax:
Phone No.
E -Mail:
l A/lk QS -(J
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: 1
Company:.
*moi
Address:
k
City': rrC.c.e.,L ,
Zip Code: - �Pb
Stateyy:;;�,�i���;;
Fax: xis` rr
Phone No.
E -Mail:
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State or County License:
A C cy;-1:44
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION;
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
City:
Zip:
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: _ _ Phone.-
FEE
hone;
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
com.mencing work or recording our Notice of Commencement.
Signature of weer/ Lessee/Co r for as A en or Owner
STATE OF FLORID
COUNTY OF '
The fRraoing instr nt w acknowledged efore me
thiso` ,clay af�� � y
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signatur''@►of NNary Public- State (?'FloriH;;
Commission
REVIEWS FRONT + ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Signature of ntractor/Licens H lder
STATE OF FLORIQA�
COUNTY OF
The fo l�oing ins�upert was a knowledge efore me
this day of — 2C] by
Name of person making statement
Personally Known FOR Produced Identification
Type of Identification
Produced
itiQnatuf fVttary Public State of Florida) ! ��
JOYCE WGF� , JOYCE
►wry F'+A>dn rA
SUPERVISOR I PLANS I VEGETATION I
REVIEW l REVIEW + REVIEW