HomeMy WebLinkAboutBuilding permit appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: w
i- k
H
u I
Lot No.
Property Tax ID#: i2OI I
�
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK:
one[
4; � s
CONSTRUCTION INFORMATION:
--
itiona wor to (e�er orme un er t is permit - c ec a
❑Gas Piping
app Y:
Shutters
Windows/Doors
❑HVAC
L J
Gas Tank
_
Roof pitch
❑_ Electric Plumbing Sprinklers
LJ Generator
Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Building Height:
Construction: ri Utilities:�Sewer
Cost of Gnst $
Septic
OWNER/LESSEE:'
JCONTRACTOR:`
- C-
Name
Name: �r., r,.{f+
Company: a 4Y\
H ►p�'�
Address: I f�.' --_
City: Ip; p � p- State: L
Address: (PO.SI 3�C4"
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L
�F-
Zip Code: �y °I—S�— Fax:
City: ' c �' �'` R�_�-�
Y� emu=—�-
State:
-
Zip Code: 3 ) c> �� � Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail:
�c
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
i
�-SUPPLEMENTAL CONSTRUCTION
DESIGNER/ENGINFFR: Not
f\ddrls'S5;
riry
Phone
UEN LAW INFORMATION:
State
cable I MORTGAGE COMPANY: _ Not Applicable
Name:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City: State:
zip:,—. Phone: _
BONDING COMPANY _Not Applicable
Name:�� .
i Address:
City:
Phonea:� ;Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as+indicated.
I certity 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.
I'he following building permit applications are exempt from undergoing a full concurrency review: room additions,
<rc;cessary 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." _
_......
r,: tt.rre r caner/ lr7ssee/r.UntraCtClr as Agent for Owner
STATE OF FLOJIDA
(-O[.JNTY OF_.._._�-(� Yl_N v -
!nstru,[lilnt was acknowledged before me
-4ki of _ Ft*t1►c& y J.., 20?�I by
0 'rr
Name of person making/statement.
/ OR Produced Identification • ersonally Known
Type of Identification
Signature ZU
ntractor/License Holder
STATE O IDA j
COUNTY OF,Q�jf�_
The forgoing instrt=nt was acknowledged before me
this _ Jtday of tpefyV:,ty 20 _ by
--f....A n L
Name of person making statement
Personally Known / OR Produced Identification
Type of Identification
ri`�Mure of pOtary PunW__ blic Slate of Florida 1 ; (S Nature of Motary Public State of Florida
� µ) `
Commission No.1L n No. 151.629*1 S
Pubk of F I*
Jen Nei Ry PublicS�cinrdorids — - -- Jennifer
� M Stateichmond
GG �1111
I 7 3i pires 05/21/2023
REVIEWS i FRONT { Z I P N I VEGETATION S lMLN1CAN)
COUNTER ( R I • REVIEW REVIEW I REVIEW
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