HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLE? -__ 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 FC 34982 -"
Phone: (772) 462-1553 .Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 1 ) O
Legal Description:
Z-
Property Tax ID #: S ls8c� • tib& u3Z0' ()OOO Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left.Side:
aitionai work tone pertormea unaer tnis permit- cnec
_Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ Z300
_ Shutters _ Windows/Doors
_ Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name e- JQcAQ_ x Yl
Address: 1 11 D (. too r-2.
City: .rr State: 'k�L
Zip Code: 51 9 5� -Z- Fax:
Phone No. :-]7— '� . (" -tip 8
E-Mail: k,,,i-rt . s'2" I (P. k 4m n, I - 0 mv► )
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:,.
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not App
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: _ . - - -----._.r -- - - - -- -- --- - -
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 and covenants thatmay 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 y intend to obtain financing, consult with lender or an attorney before
commencing wodk or.recor g vour Notice of Commencement.
Si ature of Owner/ Lessee/Contractor as Agent for Owner...
Signature of Contractor/License Holder
STATE OF FLORIDA
\\
STATE OF FLORIDA
COUNTY OF -1NA"tea
.
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 2011 by
The forgoing instrument was acknowledged before me
this day of . 20_ by
(Name of pe son acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- S to of Florida)
(Signature of Notary, Public- State of Florida )
Personally Known
OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Nduced
Commission No.
Seal)
Produced
Commission No. (Seal)
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Rev. 7/2014