HomeMy WebLinkAboutBuilding Permit Application ALL 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
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ________ Residential ________
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: __________________________________________________________________________________________
Legal Description: ___________________________________________________________________________________
__________________________________________________________________________________________________
Property Tax ID #: _________________________________________________________________ Lot No.__________
Site Plan Name: __________________________________________________________________ Block No. _______
Project Name: ______________________________________________________________________________________
Setbacks Front__________ Back: _________ Right Side: _________ Left Side: ________
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit – check all that apply:
__ HVAC __ Gas Tank __ Gas Piping __ Shutters ___ Windows/Doors
__ Electric __ Plumbing __ Sprinklers __ Generator ___ Roof
Total Sq. Ft of Construction: ___________________ Sq. Ft. of First Floor: _________________________
Cost of Construction: $ _____________________ Utilities: __ Sewer __ Septic Building Height: __________
OWNER/LESSEE: CONTRACTOR:
Name__________________________________________
Address:________________________________________
City: _________________________________ State: ___
Zip Code: ______________ Fax:____________________
Phone No._______________________________________
E-Mail:_________________________________________
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: __________________________________________
Company: _______________________________________
Address: ________________________________________
City: ______________________________ State:____
Zip Code: ________________ Fax: __________________
Phone No. _______________________________________
E-Mail: __________________________________________
State or County License: ____________________________
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Roof pitch
latif
DESIGNER/ENGINEER:
Name: Judy Norris
Not Applicable Not Applicable MORTGAGE COMPANY:
Name: David Kruse
Not Applicable BONDING COMPANY:
Address: 8605 Oneco Way Address: 6605 Oneco Way
FEE SIMPLE TITLE HOLDER:
Name:
Address: 1853 Mums Street
City:
Zip:Phone:
Name:
Address:
City:
Zip:Phone:
City: Fort Pierce
Zip: 34951 Phone
City: Port Saint Lucia
Zip:
Not Applicable
State: FL State:
Phone:
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF Sc:k Lucie.
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF bait.* x-s-K' le
The for oing instrument was acknowledged before me
this day of crick-um-1 2O. by
Ala •
/ U Kruse
Name of persoq making statement
Personally Known ••/ OR Produced Identification
Type of Identification
Produced
The forgoing instrument was acknowledged before me
this 23 day of re byti 0 P-1 20_21, by
--bavid 14-use.
Name of person making statement
Personally Known vr OR Produced Identification
Type of Identification
Produced
42o Lehi--42c: teivi at
Raid* Forty (Signature of Notary Public- State
NOTARY PUBI4C
STATE OF FLOPMaqmmission No.3
canny, GG3613087
Expires 7/29/2023
of orida ) Raschel Fry
It9TARY PUBLIC STATE OF FLORIDA
Come GG360067 Expires 7/29i 2023
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary Public- State ofFl
Commission No.C763‘,0009\1
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 Opt 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 your Notice of Commencement.
Rev. 8/2/17