HomeMy WebLinkAboutBuilding Permit Applicationit
All APPLICABLE i� _O%M ST E
Date. ` �� I
LrrED FOR APPLICATION TO BE ACCEPTED
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
ERMIT APPLICATION FOR:
Haaress: r/1ri�
Legal Description:
v
Residential
Property Tax ID #:CoOoS Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Sid _10�_ Left Side:
Mechanical _ Gas Tank J Gas Piping _ Shutters
Electric _ Plumbing _ Sprinkler — Generator
Total Sq. Ft of Construction: (�L/ Sq. Ft. of First Floor:_
Costypf Construction: $ 07&DG Utilities: —Sewer —Septic
Name =--4///V UCJ►' N✓L/ /L/
Addlress: S
Cityi � �t�i(i`-� State• I
Zip Code: Fax:
Phone No.
E-Mail:
Fill inl fee simple Title Holder on next page ( if different
from, the Owner listed above)
Name:—/
Company;
Windows/Doors
Roof Pitch
Building Height:
City: C, M4 State:
Zip Code: Fax:
Phone /No 7 ✓��Z�G
E-Mai1��G
State or C my License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
NER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: 1 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:
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 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
commenx-im work or recorAinR your Notice of Commence ]
ure of
STATE OF FIKQRI
COUNTY OF
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