HomeMy WebLinkAboutbuilding permitALL APPLICAB E IN VO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C 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 L-1�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Legal Description:
Property Tax ID #:
Site Plan Name:. 1�
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side; Left Side:
Lot No.
Block No.
CONSTRUCTION INFORMATION:
AdLd
itio wor k to e e orme un er is permit —Check a apply:
HVAC � Gas Tank ❑Gas Piping _ Shutters Windows/Doors
11 Electric Plumbing Sprinklers Generator L] Roof Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $
OWNER/LESSEE:
AAddress:
All
State:
Fax:
Phone No. ^ (�
E-Mail:
S Ft. of First FIoor: _
Utilities:l Sewer OSeptic
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
�LCONTRACT R:
Name:.
Company: 1
Address:
City:{ State:I -
Zip Code: 0%2q&O Fax: 14W.
Phone No.
E-Mail:AYR 00�u
State or County Li ense:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION;
DESIGNER/ENGINEER:
Name:
Address:
City: �-
'Zip: _ Phone
FEE SIMPLE TITLE HOLDER:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
State,
Not Applicable
I MORTGAGE COMPANY:
Name: _
Address:
City: - -----
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 y work or installation has commenced prior to the issuance of a permit.
which is in conflictwithwith any applicableiHo eat is Ownersting Asssociati nipermit
lesabylawszor and covenants that build
olrr prohibit such
structure. Please consult with your Horne 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/C❑ raftorasA en or Owner
STATE OF FLORID
COUNTY OF '
The Nyjaing..instrume vu as j
_ knowledg fore me
this— day of _ _y
Name of person making statement
Personally Known ye::� OR Produced Identification
Type of Identification
Produced
(SignaturPof NDtary Public- State n�'Floriria 1
Commission
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Signature of ntractor/Licens H ]der
STATE OF FLORIDA
COUNTY OF �;j Jai -L �
The r r ping ins �u t wa. cknowledg — afore me
this day of 2 y
Name of person making statement
Personally Known e�OR Produced Identification
Type of Identification
Produced
f1,i0n;Jtu?1&Af 1Atary Public -State of Florida )
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SUPERVISOR PLANS VEGETATION I
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