HomeMy WebLinkAboutpermit ApplicationALL 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: To Select from dropbox, click arrow at the end of line
Legal Description:
Property Tax ID #:(jUla (i2®' I Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
Aaaiuonaiworxtooe errormea unaertnispermit—cnecKauma apply:
�HVAC - Gas Tank Gas Piping Shutters ® Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq, Ft. of First Floor:
Cost of Construction: $ 75) a3q 4l0 Utilities: 0 Sewer 0 Septic Building Height:
ONJNE�/LESSEE_ •
CONTRACTOJ2
Name 1AU4
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Name: 11 P lnvY U
Address:
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Company:WMJLJ
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City:
State:
Address: M I 1
(1,
Zip Code:
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City: ALOk✓
Stater
Phone No.
Zip Code: n33 (b
Phone No. S(9i- _ q
Fax:
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R01( 2U�4)ZM
E-Mail:
Fill in fee
simple Title Holder on next
page ( if different
E-Mail: fJ mt S
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State or County License: CC
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from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name: _
Address:
City: _
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Phone:
BONDINGCOMPANY: _Not Applicable
Name:
Address:
City:_
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
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory us
WARNING TO OWNER: Your failure to Record a Notice of Commencement ma
improvements to your property. A Notice of Commencement must be reco
before the first inspection. If you intend to obtain financing, onsult with le
commencine work or recording vour Notice of Commencement. I
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA�ae �^ COUNTY OF Y'e�(
The ing instru ant vya cknowledge afore me
this I
(Name of person acknowledging
(Signature
Personally Known !
Type of Identification
Commission No.
Revised 07/15/2014
State of Florida )
OR Produced Identif
ication
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The forgoing ins
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and posted on thejobsite
or an attorney before
acknowledged before me
20 by
ame of person acknowledging
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(Signature'of Notary Public -State of Florida )
Personally Known' OR Produced Identification
Type of Identification Produced
Commission No.
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My Commission nn ueosur
Expires 08105/2024
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