HomeMy WebLinkAboutBUILDING PERMIT APPLICATION$ri .$$\$rl$Ss
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Plonning ond Development Services
Building ond Code Regulotion Division
2300 Virqinia Avenue, lort Pierce FL 34982
Phone: (772) 462-1,553 Fax: (772) 462-1,578
PERMIT APPLICATION FOR: Etectrical
Commercial Residentia I
PROPOSED IM PROVEM ENT LOCATION :
Add ress:
Legal Description:
Property Tax lD #:
Site Plan Name:
Lot No.
Block No.
Project Name:
Setbacks Front Back: _ Right Side: _ Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION I N FORMATION :
Tn Windows/Doors
Roof
Total Sq. Ft of Construction: _
Cost of Construction: $Building Height:
OWN ER/LESSEE:CONTRACTOR:
Name Name:
Add ress:Com pany:
City:St ate:Address:
Zip Code:
Phone No
E-Mail:
Fax:Citv:
Zip Code:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Phone No.
E-Mail:
State or County License:
Fa x:
State:
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
oESiGrurC/ENGINEi* ruof nppiica6ie MORTGAGE COMPANY:
Name:
__ Not Applicable
Name:
Ad d ress:
City:State:
Phone:
Add ress:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable BONDING COMPANY:
Name:
Not Applicable
Ad d ress:Add ress:
City:City:
Phone:
lcerlify that no work or installation has commenccd prior to thc issuancc of a pcrmit.
St . Lucic Counlv makcs no renrcscntation that is granling a permit will authorize thc permit holder to build thc subject structurc
;rhiihi;iii"c"riltiti*irt 'inv'jijriticauict-toriieowiieislsiotiaiioniulcs,bylawsorandcovcnanlsthatmay,r.eslrictorprohihitsuch
itruiiuie. ptease Consut[with your Home Owncrs Association and review your deed for any rcstrictions which may apply.
In consideration of the granting of this requestcd permit, I do hcreby agree that I will, in all respects, perform 1he work
in accordance with thc approved plans, thc Florida Uuilding Codes and St. Lucie County Amendments.
The following building pcrmit applicalions are exempt from undcrgoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residcntial use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
ments to your property. A Notice of Commencement must be recorded and posted on the- jobsite
the first inspection. lf Vou intend to obtain financing, c t with lender or an attorneV before
!1_qlteqoldiry_y9gr=N,-o_!qe__qf_q_lry1qnce!!
Owner/Lcsscc/Contractor as Agent fr>r Owncr actor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument
this day of
was acknowlcdged before mc
,20. lry
STATE OF FLORIDA
COUNTY OF
thc forgoing instrumenl was
t his . day of
acknowledged bcfore mc
Personally Known
Type of ldentification
Commission No.
Rt-'viscd 07l15l)014
OR Produced ldentification
[)rod uced
20 by
OR Produced ldentification
[)roduced
Personally Known __ __
Type of ldentification
Commission No.
PLANS
REVIEW
REVIEWS
DATE
COMPIETE
IN ITIALS
FRON I
COUNTER
ZONING
REVIEW
SU PERVISOR
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVII
REVIEW
.r b^ Floricta
0- -q
.'^ -I : 55732
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