HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONai i naai irAw F uuFn mi v;T RF rnMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
� Permit Number: 190%
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St Lucie CoMy
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2360 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
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side
DETAILED DESCRIPTION OF WORK:
''CONSTRUCTION, INFORMATION:
IA'dditional work to be D orme . under this permit - check all apply:
I[JHVAC LJ Gas Tank Gas Piping Shutters 'ndows/Doors
Electric Plumbing Sprinklers Generator _Roof Roof pitch
T,Ital Sq. Ft of Construction: % S . Ft. of First Floor:
Cost of Construction: $ �f LYE Utilities:Sewer o Septic Building Height: f
CI
(JWNER/LESSEE:
CONTRACTOR:
Naime
Name: `
Company:
cc
Address: /_ C�? h6l !
Address:
City : � Stater
Fax:
City: State
PhiZ.No.
Zip Code:_ V9.5"Jr Fax:
E-Rail:,,
Phone No. VFW -
E-Mail: ,/ y
State or County Licens : !
Fill in fee simple Title Holder on next page ( if different
fromll the Owner listed
above)
II
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
Name:
Address:
City:
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
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF24- J �a, DQlvr/L
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this�/L day of/J./d%20J,0 by
this day of 20_ by
/
Name of person making statement
Name of person making statement
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
11�
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
'09 Pv*, USAN
Commission No. 2 •' '• ° SUSA450
Commission No. (Seal)
f°1� c� EXPIRES; May 20, 2021
�OF
��P 60fxled
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17