HomeMy WebLinkAboutDocument (38)ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
F- L O.. FL , 0 p
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
Prc-perty Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
i�
Ct
Right Side: Left Side:
Lot No._
Block No.
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to e er orme under this permit — check a appy:
HHVAC M Gas Tank F]Gas Piping _ Shutters ❑ Windows/Doors
Electric ❑ Plumbing Sprinklers ❑ Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ `" RQ J �——
1 () n
SFt. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name \-i, —
Name:
Company:
�t
Addr
City: State:
Zip Code: 3es
� -1 I Fax: ,
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Phone No. �(� I- �� L1 �Y I
Address:
City: j�,l .(r� (1 t Wit'
Zip Code: 3
Phone No. —
Faax::�7
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Stater
E -Mail:
Fill in fee simple Title Ho�der on next page ( if different
from the Owner ".ested above)
E -Mail:
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State or County License: �_ PFC 0
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
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 OWNER: Yo failure to Record a Notice of Commencement may result ' your paying twice for
improvements to your p erty. A Notice of Commencement must be recorded/d posted on the jobsite
before the first ' If you intend to obtain financing, consult a or an attorney before
commencinkigorkOt r cordine vour Notice of Commencement.
Signatu
as Agent for Owner I Signature of Contractor/License Holder
STXfE OF FLORIDA /' } �/J STATE OF FLORIA /' 1 �-
COUNTY OF �JiA�LU COUNTY OF LUQ
Thefor oing instrument w s acknowledged before me
thisA day of 0_-t/L , 20 Zby
t�,i,F
(Name of p rson acknowl
(S(gnature of Pudic- id
Perso 0
Type of I en i i
Commission cS;
Revised 07/15/2014
The forgoing instrumef t yvas acknowledged efore me
this Aday of Q J % 2 by
0"�
(Name of a on acknowle ng
(Sig ture of N P , Florida )
4,5
�NROS� 910 9
Personally Knn R fopll ski ion
Type of .. Nl;
(Seal)
0
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS