HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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� Date:. Permit Number: 6
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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
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LegalDescription:Property Tax ID#: Coo L Lot No.
Site Plan Name: Block No.
Project Name:Setbacks Front a Back: Right Side: Left Sidlel 4:�__
ec a app y:
Shutters QWindows/Doors
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Electric 0 Plumbingg ❑Sprinklers Generator E]Roof
Total Sq. Ft of Construction:�v i S . Ft,of First Floor:
Cost of Construction:$C L, ?�L L Utilities:�Sewer ElSeptic Building Height:
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Name Name:
Address: Company:
City: State:_ Address: N d—
Zip Code: Fax: City: R Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: J(7 l""ii7� 1 .S /v «)
from the Owner listed above) State or County License: np w
'If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEE 7 _Not Applicable MORTGAGE C, PANY: _Not Applicable `
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPL�HOLDER: _Not Applicable BONDING MPANY: _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: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.
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ignature of Owner/Lessee/Agent nature of Contractor/Licen a Holder
STATE OF FLORIDA STATE OF FLORI
COUNTY OF COUNTY OF
The for oing inst u ent was adknowledgpVbefore me The for ping instru en was ckno gedpefore me
this day of 20ti0 by this day o 20 by
(Name of person ackn ledgi ) (Name person acknow edgi g)
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(Signature of Notary Public- ate of Florida) (Signature of Notary Pu ic-State of Florida)
Personally Kno n OR Pro Person ly Known OR Produced Identification
Type of Identific do Pc d ;y p�t;ssta: Type of I en ' ' i
Frances Donza Notary Public State of Florida
Commission No. y Comnlptw G 092440 Commission o Donza (Seal)
?or�o Expires 07/27/2 21 c My Commission GG 092440
4 OF�o� Expires 07/27/2021
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS