HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLI ABL 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
.FPERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal De
Property Tax ID #:
Site Plan Name: a""v
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
r)0o ?-
Right Side:
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I CONSTRUCTION INFORMATION:
Additional work to be oerformed under this permit —c
IVAC Gas Tank Gas Piping
11 Electric ❑ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 500
Lot No. OW
Block No.
Left Side:
ail apply:
_ Shutters Windows/Doors
❑� Generator Roof Roof pitch
Sq, Ft. of First Floor:
Utilities: Sewer[] Septic
OWNER/LESSEE: I CONTRACTOR:
Name
Add rest
City: Stater
Zip Code: y`,� Fax- �?
Phone No. ]07 �• %r/d�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height-
Name: '
Company:
Addr
City: U State:
Zip Code: ��7G0 Fax: ]lob df -
Phone No. _9710 • 3:�- 3 306)
E-Mail : /IJrtr.CS.�]r
State or County icense: 6C05
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPlEP�1tEWTAE CQ1*ETRUI't0�1 LP1 LAB INFORMATION. ^
DESIGNER/ENGINEER:
J Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
State: City:
Zip: Phone
_State:
Zip: Phone.
FEE SIMPLE TITLE HOLDER:
_ Not Applicable BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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.
Wa0zAp (:� 4.-I�
Signature of wner/ Lessee/Col
essee/Co r or as en or Owner
STATE OF FLORIDA, � y�
COUNTY OF yQ,�� �. A
The for ng instrum nt was cknowledgQd before me
this day of�� 20�by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signatur'l�of NDtary Public- St;atP n''Floriria 1
Commission 4. ; C—ayook—)
REVIEWS FRONT ZONING
j COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
_WLdapqzg��
Signature of ntractor/LicensH61der 61
STATE OF FLORI
COUNTY OF j P4\ 1. .1 JeP-
The For¢�Aing ins;L nt was acknowledged before me
thisp%is day of _ zG/ by
Name of person making statement
Personally Known �OR Produced Identification
Type of Identification
Produced
Ma
OttU IIJ-7-
Ir i
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Public- State of Florida )
SUPERVISOR PLANS VEGETATION I
REVIEW REVIEW REVIEW I
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