HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONn
All APPLICABLE INFO MUST BE COMPLETED .=.:,.`::.APPLICATION TO BE ACCEPTED
Date: Permit Number: Oo� •� It ��
SCANNED
BY
_.. Ste Lucie, County
Plannir}Ig and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phonee (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Addres i��
Legal D scription:
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Building Permit Applicatioris�r���9
Commercial Residential a
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Propert Tax ID #: Lot No. %.
Site Pla Name: Block No.
Project�ame: D
Setbacllas Front Back: Right Side: Left Side:
Total Sc
Cost of
al work to be pertormed under this permit— check all that apply:
zhanical _ Gas Tank —Gas Piping _ Shutters
ctric _ Plumbing _ Sprinklers _ Generator _
Ft of Construction: Sq. Ft. of First Floor:
)nstruction: $ m/2 ��iD• oo Utilities: _Sewer _Septic
W' indows/Doors
Vloo f Pitch
Building Height:
r
Name /' Name:
Addre4:: � R Company:
City: State:Address:
Zip C Ide:3W-51 Fax: City: State:
P h o n E No. Zip Code: Fax:
E-Mai c Phone No
I
Fill in ee simple Title older on next page ( if different E-Mail
from the Owner listed above) State or County License
If value Of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable
,. MORTGAGE COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE. SIMPLE TITLEHOLDER: of Applicable
BONDING COMPANY: Applicable
Name:
Name:
Address:
Address: J.
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.
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 I
commencing w r recording our Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OFF
STATE OF FLORIDA
COUNTY OF
The f rgoing instru nt was acknowledge before me
this .day of 20bi by
. The forgoing instrument was acknowledged before me
this day of 120 by
v,.O� A-3
Name of person making statement.
Name of person making statement.. I
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
—(Iighature of Notary Public- Stat f Florida)
(Signature of Notary Public- State of Florida)
Commission No. - - (Seal)
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Commission No. (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
i.
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
'
RECEIVED
o
DATE
COMPLETED
Rev.8/2/17
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