HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED,FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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_ _ St Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce A 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select l� rom dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:.
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Address: �Q , Vfr • f ►
Legal Description: L �� , I `k__ T , LV I
Property Tax ID #: C )I JI C-- Qk— QU f;•- UU-)—1 Lot No.
Site Plan Name: n:�Cj i Block No.
Project Name: 1LT�t
Setbacks Front Back:, Right Side: Left Side:
DETAILED DES'CRIFTION QF. WORKIF
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CONSTRUCTION. INFORMATION -
Additional work to a r orme under this permit- check a apply:
-HVAC q Gas a4Lk ❑Gas Piping _ Shutters ❑ Windows/Doors "
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ I �vl� Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
-CONTRACTOR:
Nam en
Name:
Address:jof
Company: & _
City:
Zip Code:5�1F x:
Phone No.—fla •—
State
Address.
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City:
Zip Code: F
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=ill in fee simple Title Holder on
frIam the Owner listed above)
ext page (if afferent I
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E-Mail: Par Y►'lQl
State or unty License:
If valixg of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF F
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STATE OF FLORID_ Lot
COUNTY OF J-t
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The i instru n s a <nowledg efore me
The f i g instrum nt v s ack owledged re me
thi day of 20_ by
thi y of 20_�
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Name of r on making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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DATE
RECEIVED
DATE ;
COMPLETED
Rev. 8/2/17