HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE 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_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROP 0SED'IMPROVE-MEN T LOCATIO
Address:
Legal Description: COO
Property Tax ID #: t_--3Jra756
Site Plan Name:
Project Name: /27lam_
Setbacks Front Back:
DETAILED DESCRIPTIONII,, OF W(
_ Right Side: Left Side:
Lot No. c?
Block No.
Additional work to be
nertormed
under this permit— check
all
apply:
�HVAC
Gas Tank
❑Gas Piping
_Shutters
Q Windows/Doors
Electric 0 Plumbing
Sprinklers
E Generator
E]Roof
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $
Utilities:Sewer
0Septic
Building Height: _
OWNER/LESSEE: < �a
CONTRACTOR:.
Name md-70
Name:
Address: oZ 41
IN
Company:
City: State:
Address��ad V
Zip C de: Fax:
City: 4�ze State:
Phone No.
Zip Code: Fax: UZ/2
E-Mail:
Phone
Fill in fee simple Title Holder on next page (if different
E-Mail: C,eiV ir!
State or County License:
from the Owner listed above)
it vawe or construction is ti-,zbuu or more, a KCwKutu Notice of commencement is required. '
SUPPLEMENTAL.CONST.R:UCTI,ON LI.E'N LAV
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
INFORMATION:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 your Notice of Commencement.
Signature of Owner/ Lessee/Agent
of Contractor/License
STATE OF FLORIDA STATE OF FLORID
�:Al &6L
COUNTY OF COUNTY OF
The fo going instr ment was acknowledged fore me
this day 20 by
(N�f person acknowl dging )
(Signature of Notary Public- St4ke of Florida )
Personally Known OR Produced Identification
Type of Identification Produc
or Notary Public State Of H
Commission No. !J d s Donza
� y mmission GG 092440
'►n.a� Expires07127/2021 - -
Revised 07/15/2014
The for oing ins nt was acknowledgV before me
this day of 20by
(Name person acknowledging)
(Signature of Notary Public- ate of Florida )
type
Known OR Produced Identification
tripe of Identification_Fr4duwd f
�nr a� Notary Public State of Florida
n No. °4� _Frances D�6�I)
E� My Commiss on GO 092440
Expires 0712712021 _
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS