HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _
Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Building Permit Application
Commercial Residential
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Property Tax ID #: Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
—Mechanical GasTank —Gas Piping —Shutters
�Plumbing
_ Electric Sprinklers — p _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ Q Utilities: _ Sewer — Septic
Name f412,-, - - L ran m�
Address:
City: . 1 r-► State: FL
Zip Coder Fax:
Phone No. '7"7 ;1 — 4(e, S',
E-Mail:`' 1 1--IUn 10
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
— Windows/Doors
— Roof Pitch
Building Height:
Name:
Company: -�
Address: ��.
City: , Q State: 'FL —
Zip Code:ajl- Ct �� Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
LEMENTAL CONSTR
Not
EM
LIEN LAW INFORMATION:
Name:
Address:
City: State -
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: _ Phone:.
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 ancovenants 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 wort,
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 JOB SITE BEFORE THE FIRST INSPECTIIONR IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT-7
Signature
Owner I signature of Contractor/License Holder
STATE OF FLORIDA- I I STATE OF FLORIDA
COUNTY OF , I it; 14, 1 COUNTY OF
The forgoing instrupent Was acknowledged before me
this l&day of 6 20M by
Name of person making statement.
Personally Known OR Produced Identification
Type of IdentIficat1an7X__
Produced
L`o- iYY'
Y
_f5fjnat6ie'D'f Notary* Public- St
-Q. Notary Public Stale of Flo al
Commission No. (, P-4 Lrsa L aullerfield
GG 302065
0211412023
REVIEWS I FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
COMPLETED
The forgoing instrqfnentwasacknowledged before me
this —4-day of M/4j 24 by
bt-'r
Name of person making st#tement.
Personally Known OR Produced Identification
Type of Identification
re of Notary Public -State of
�00X' 10# Stale
fi -ebSSa L Bute fie:
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SUPERVISOR I PLANS I VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW