HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr .
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: SCANNEV) Permit Number:Pt Lucie 01,
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Building Permit Application g. oena►1e°ti
Planning and Development Services Per^�i. Lucre County
Building and Code Regulation Division St.
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578i Commercial Residential �/ 1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P.RUPOSED ItlIVI,PRQVEIVI.INT,LO*CATlC3N:X.
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Address:
Legal Description:
Property Tax ID #: At , Oh � Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
11HVAC Gas Tank Gas Pi
11 Electric 0 Plumbing ❑Sprinl
Total Sq. Ft of Construction: k
Cost of Construction: $
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Utilities:;
J Generator
Ft. of First Floor: _
ISewer O Septic
Building Height:
OWNER%LESSrEE„
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CONTRACTOR
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Name
Name:
Company: _
Address: �1� �_1� 'fitA
City: "��_,�-�sti► : _
Address:
City-
Staters--
Zip Code: Fax:
Phone No. ���S''
Zip CodeC195;? Fax:
E-Mail:
Phone No. 'y—Z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: C- a 4 1`�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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S11 PLEMENTA CQNSTRUCTI N LIEN ,I,AW 1 I
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DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
:ommencing work or recording our Notice or uommencemenE.
Signature of Owner/ Lessee/Contractor as Agen for Owner Signature of ntractor/Lice se Holde
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 1��1 20_ by this _�_ day of !MA� , \ , 20L�_ by
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\ p w u �.. 1_19 son making atement Name of person aking statf4ment
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
of Notary Public- State d'
Commission No.
- �tya?ture Notary Pub, = Sta£e;of Florida kiAliNA INGRAty�
LDS AHNp tN C: '`� R y'� P:otary Public State of Flo
hlJtar} " ;fate of Florida
ut�llc Comoi55i6b o. "�'.(� ;. My(WgI,)ExpiresDec 20.
My DOmT' E,pir ,s ��� i kw
:N �,; Commission # FF 177'
Commission k FF 1772A9
°'F;°� Bonded through National Not,
__—h N: rional Notary Assn. �,����� w;:: :•
REVIEWS I COUONTER I REEVIEW S OR PLANS REVIEWI REVIEW I VEGETATIONI S REVIEW LE MANGROVE
EWVE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17