HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLIC BLF IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
a
- " 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 l�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IM PR YEM ENT LOCATION:
- - - - -- -� -- --- - - ---- - - -
Address:
LL
Legal Description;
Property Tax ID #: Lot No.
Site Plan Name: I Block No.-�
Project Name:
Setbacks Front Back: Right Side: _ Left Side:
DETAILED DESCRIPTION OF WORK:
(ML 04&q a� It
I CONSTRUCTION INFORMATION:
itio wor to e e orme un er is permit -check a apply:
VAC � Gas Tank ❑Gas Piping _ Shutters Windows/Doors
U Electric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: ${{�.� Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE:
I CONTRACTOR:
Name Name: `
'
I
Address: t' %� Company: '
City: L� State:' A Oress:
Zip Code: Fax: City: State::(
Phone No. �� U Zip Code: ?:a() Faa�x��s9I94'`411
E-Mail: Phone No. _"�40�
Fill in fee simple Title Holder on next page ( if different E-Mailgi i lii S,6pq
from the Owner listed above) State or County License: COI
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION UEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: _ Phone
FEE SIMPLE TITLE HOLDER:
Name: --
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone: ^
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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 our Notice of Commencement.
Signature of Jwnerf Lessee/Co r or as en or Owner
STATE OF FLORID
COUNTY OF
The fRraoing instr4ipent was acknowledged before me
this 1>,� day of 1) , 20'1 by
Name of person making statement
Personally Known %,--- OR Produced Identification .
Type of Identification
Produced
(Signatur'>y of Nlitary Public- State
Commission
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
"NINL9AP9 llja�
Signature of ntractor/LicensAlder
STATE OF FLORI (�
COUNTY OF �' P^ `4 1 S)
The f going instCu enr was ackncwledg efore me
this,.day of W 2�lby
Name of person making statement
Personally Known FOR Produced Identification
Type of Identification
Produced
a i Kiunatu%41f N`8tary Public -State of Florida)
Em
' �''' �` l' p: JOYCEMICHWac.ARLo
My�#oQ�o �rr��ecroo
par,eed�pI �. 2022 yy BaadWd DM& Apt 2F.. 2022
y p�
SUPERVISOR PLANS VEGETATION I
REVIEW REVIEW REVIEW i