HomeMy WebLinkAboutBuilding Permit Application 10-26-17ALL 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
PROPO.SED,IMPROVEMENT LOCATION:
Address: d.J&AVt
Legal Description: (' 11�� Agai
Property Tax ID #: �J v� ! �(� �„ �C� i " b Lot No. A5,
Site Plan Name: Block No.
Project Name:�,(���
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION`OF WORK:
Aooitional worK to lie nertormeci u
E1HVAC _ Gas Tank
Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
this permit — check all apply:
❑Gas Piping M Shutters Q Windows/Doors
Sprinklers " 1:1 Generator E] Roof
S Ft. of First Floor:
Utilities:Sewer 0Septic Building Height: _
OWNER/LESeE: ;
CONTRACTOR:;
Name n
Name:
Addressss:� -'21 _
Company:
City: l �/lQ�/J?lcl.C'/�. State: ,
Address:IF
Zip Code: Fax: A/%
City: L!/ Stater
Phone No.
Zip Code: _ ��/� Fax: 41.4
E-Mail:
Phone No. `Jw" —
Y/
Fill in fee simple Title Holder on next page (if different
E-Mail: r-zfw ig ow -Arty 4,e.5
f-• COh�
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW I4FORM'ATION:
DESIGNER/ENGINEER: _ Not Applicable
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:
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.
s
_ Signature of Owner/ Lessee/Agent Sjg`ntiture of Contractor/License Holder
STATE OF FLORIDAJ
COUNTY OF /
The f rgoing ins u ent was acknowledge efore me
this day of 20 j .by.
(Name of erson acknowledge g )
- CGO
(Signature of Notary Public- Sta of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Revised 07/15/2014
No(Setrl) id State of Florida
Frances Uonza
My CornmiSWOS (A 092440
STATE OF FLORIDA
COUNTY OF Aak==
The forgoing instrum t was acknowledged efore me
this V'5day of 20 by
(Name of person acknowledging )
(Signature of Notary Public- State o orida )
Personally Known WRP�r�odType of Identification Pto of Floridaof FloridaNOW IF
rances Donz GG092440Commission No:y Com{Q�ExPtreg 7!2 �1
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