HomeMy WebLinkAboutbuilding permitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��°43 �b
Permit Number:
c.
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
l� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Des
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Commercial
.cU_)0—S
Back: Right Side
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Aadiflonal work to rforFFea under this permit — c ec a
1]HVAC GasTank ❑Gas Piping
11 Electric � Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Name I
Address:
Sta
Zip Code:-,,,,��++ Fax:
PhoneNo�zz-21A,. `Z�C�
Lot No.
Block No.
Left Side:
apply;
Shutters Windows/Doors
[_Generator Roof Roof pitch
S Ft. of First Floor: _
UtilitiesSewer Septic
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company: r ��
Ad ess:�
City: -
Zip Code: �I
Phone No.
E-Mail: t
State or County License:
If value of construction i $$2500 or more, a RECORDED Notice of Commencement is required.
Building Height: _
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION;
DESIGNER ENGINEER: —
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable BONDING COMPANY:
Name:
_W 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
commencing work or recordin our Notice of Commencement.
Signature of wner/ Lessee/Co r for as en or Owner
STATE OF FLORID
COUNTY OF
The f r oing instir i nE was acknowledged before me
thi� day of � 2&IZ)by
Name of person making statement
Personally Known ��_ OR Produced Identification
Type of Identification
Produced
(SignaturP'of Notary Public- State oriH;; )
Commissionia
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17
Signatu4ofntr4actor�/Licens Ider
STATE OF FLORI
COUNTY OF ; • '
The f r ing instkum w s acknowledged me
this�day of �W 4, Zp , &
Name of person making statement
Personally Known _ ,!:�'OR Produced Identification
Type of Identification
Produced
Kia
Apd 2k =
ry Public -State of Florida )
SUPERVISOR PLANS VEGETATION i
REVIEW REVIEW REVIEW I
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