HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Address:
Property Tax ! D #:
Site Plan Name: Block No.
Permit Number, mm�
Building Permit Application
Commercial Residential
Project Name:
� r
Lot No.
`LLII
Additional work to
be performed under this
permit—
check
all that apply:
Mechanical
� GasTank
_Gas
Piping
� Shutters
Electric
_Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
A
10 W
Address.1h/s
c1tv: '7;
A01
gel;
Sprinklers
Generator
Sq. Ft. of first Floor:
Windows/Doors
Roof Pitch
Utilities: � Sewer _Septic Building Height:
Stater
Zip Code: �y� 8 2- Fax:
Phone No. 9
E-Ma'll: MI-J/1 kA 33 gpc, moo, . �cJLv
Fill in
fee
simple
Title Holder6
from
the
Owner
listed above)
Name.
It
Company.0
Address:
City: �o � State
Zip Code: �°% a/ T3 Fax:
Phone No � 0
n next page ( if different E - M aill
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
4f value of HVAC is $7.,500 or more, a RECORDED Notice of Commencement is required.
i�
71,
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY;* Not Applicable
Name.
Name:
Address.
Address:
City: State: City: State.
Phone:
zip Phone Zip:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ,,,,,,.Not Applicable
Name:
Name:
Address: Address.
city: citya
Zip: Phone: Z i P ---------- 'Phone.
O
WNER/AFFIDVIT: lit ti onis hereby made to obtain a permit to do the or and installation aindicated.
# certify that no work or installation has commenced prior to the issuance of a permit.
t} Lucie Count makes no representation that i ra ntin a r it will I authorize the err it holder t build thesubject structure
. +� r prohibit such
which i in core Pict with any applicable Hone Owners Association rules, bylaws or an covenants that may restrict
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply;
(n 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 paying twice for
improvements tc
Lucie County and
with lender or an
v I�
your property. A Notice of Commencement must be recorded in the public retards of St.
posted on the jobsite before the first inspection. If you intend to obtain financing, consult
attorney before commencing work or retarding your Notice of Commencement.
5' azure of owner/ Less ee/Cantractor as Agent for Owner
STATE OF Ft
COUNTY OF
Swvr to (or affirmed] an subscribed before me of
this day of ]� � , 2 by
Kwe %1.po'
Marne of person making statement.
Personally Known P Produced Identification
Type f Identification Produce
[Signature of Notary Pu li - State of Florida )
Commission No,(Seal)MEN&
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
ev
FRONT
COUNTER
ZONING
REVIEW
Physical Presence orOnline Notarization
a h,
. Cli _>
HUMPHREY
Pi
F 4
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW