HomeMy WebLinkAboutBUILDING PERMIT 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
Address: t-1��`-7 S .L.tvAlQln '((.�i�@.Y � lr. 1'Dr'f Pi Gt'(�G� Y1r :��19 Sli
Legal Description: 3S L[p (gel) it of N Q(en r i dt c I12 apt
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Property Tax ID #: !i 13 ' 000 000 Lot No.
Site Plan Name: _' _ Block No.
Project Name:! t({ c S
Setbacks FrontL Back: Right Side: Left Side:
DETAILED DESCRIPTION OF L
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CONSTRUCTION INFORMATIONt
LJHVAC LJ Gas Tank UGas Piping U Shutters U Windows/Doors
Electric L.J Plumbing L.JSprinklers L..J Generator L.J Roof LJ Roof pitch
Total Sq. Ft of Construction: L Q
Cost of Construction: $ 2S,
S
Ftof First Floor:
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Utilities: Sewer E]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: �$ S
Address:�{�`5
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Company: 1t()LJ
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City:cixt
Zip Code: 24:9
Phone No.171
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. Fax:
- 392 (eJW7
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City: � r
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Fill in fee simple
from the Owner
Title Holder on
listed above)
next page ( if different
E-Mail:
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State or County License:
15CC,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
3fluW[Ma:m
Name:
Addres
City: _
Zip: _
State:
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
Zip:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:_
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
St. Lucie County makes no representation that is granting a permit will authorize the permit holderto 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 Commencemen ay result in your paying twice for
improvements to your property. A Notice of Commencement must be carded and posted on the jobsite
before the first inspection. If you intend to obtain financig, consult w t lender or an attorney before
commencine work or recordine your Notice of Commenc ment.
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
this � day of �li�/L 20 %Lby
(Name or person acknowledging )
(Sig�nA ure of NotaVV Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
(6a�lAM L GLOVER
� CommisalongGG343338
Bonded i0N Budget NateryServlwe
The forgoing instrumentl�✓as acknowledged before me
this day of 'S�1Q., . 20� by
(Name of person acknowledging)
(Signature of Notary Pub/lic-State of Florida )
Personally Known `� OR Produced Identification
Type of Identification Produced
Commission No.
of Florida
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