HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:` `M 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: 5A
Site Plan Name: Pom"
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Project Name: 4gMief gPSig
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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P14c,,r 5 S,
I+ 4vindawize �r
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit —check all that apply:
F]HVAC F J Gas Tank Gas Piping 0 Shutters Windows/Doors
❑ Electric ❑ Plumbing Sprinklers [ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: _
Utilities: Sewer F] Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name I
Name:
Company:
Address: (7d
City: ; n i L_uciP State: F_L
Address: ( v
City: M_)014ec Stater
Zip Code: 34-t 96 Fax:
Phone No.
Zip Code: Fax:
Phone No.56�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail: L,t�
State or County License:
from the Owner listed above)
it value of construction is SZ5UU or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCT19N LIEN LAW INFORMATION:
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: "ot Applicable
Name: _
Address:
City:_
Zip:
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 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 your Notice of Commencement.
as Agent for Owner
STATE OF FCORIDA
COUNTY OF I.
The forgoing instruyment was acknowledged before me
this 7 dayof20 Ltby
a 441/i
. `-�
(Name of persona owledging )
Florida )
finally Known _ (,—JOR Produced Identification
of Identificatio�duced
Commission No.
Revised 07/15/2014
re
STATE OF FLORIDA
COUNTY OF _S+, L ur_ie
The forgoing instrument was acknowledged before me
this X-7 tl day of %6+ 20 �21 by
Personally Known ( OR Produced Identification
Type of Identification Produced
(Seal) Commission N
ubtic Stew
V� Notary Publid State of Florida 47,11111 • Ca� rrAs�HH 113M
rreaeriCK K Beaulieu iRis
g� My Commission GG 95o156 a�
of R Expires 01/4/2024
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