HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICAB ' INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� / Permit Number:
III
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 Description:
Property Tax ID #: _ �� 7 �(j Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side
Left Side:
DETAILED DESCRIPTION OF >WORK: t! lJ +� / CS T` - / � le-i 4e _t-2-� 0-1-
CONSTRUCTION INFORMATION:
Additional workto be nEr orme un er t is permit - c ec aMutters
py:
HVAC Gas Ta❑Gas Piping Windows/Doors
Electric ` lumbing Sprinklers nGenerator Roof Roof pitch
Total Sq. Ft of Construction:
G
Cost of Construction: $ 107,5- �—
Sq. Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name /rLzoer--
Name:
Address: i n
Company:
City: state. e: /�_
Address:
Zip Codej -? V Il' o Fax:
PhoneNo. — —
City: _ i,/� State:
Zip Code: s_ 3 tf Cj'�'"a-- Fax:
E-Mail:
Phone No.
Fill in fee simple fitle Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License:
- - - - -- --•---•-•- . rop a cv wuu-e U7 l_um Iencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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 such
prohibit
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent 9r Owner
Signature of Contractor/License older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Z,.Z day of n u 20-2/ by
this L day of 4-,- 20-;2/ by
Name of person making stat_eKent.
Name of person makingstate ent.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Va4A
(Signature otpbfary PubY State of Florida
(Signature of Nota u lic- St t of Florida )
i..ID
COm S ."' KARLEYMARIEGIESY-VARNEY
Notaryptihile StfFlorida eal)
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KARLEY MARIE GIESY VARNEY
Co 0 (Seal)
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SUPERVISOR
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COUNTER
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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