HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: { l�•(�s^t�
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Building Permit Application 3SCANNED
Planning and Development Services: - - - By
Building, and Code Regulation Division StLucie county
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial I/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#:_'?3��
Site Plan Name:
c
-Project Name: 2\ J�
Setbacks_ Front 'Back: Right Side: Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION:
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❑HVAC Gas Tank —]Gas Piping Shutters Windows/Doors
Electric- OPlumbing - 11: Spr' klers Generator Roof Roof pitch
Total Sq. Ft of Construction: q S Ft. of First Floor:
Cost of Construction: $ 7,9 0 • 0 0 Utilities: Sewer Septic- Building Height: � ar
OWNER/LESSEE:
CONTRACTOR:
Name I.0
Name:`\
Company:
Add ress: `
City: a, A State ° r
Zip Code:;5 49 $ Fax:
Phone No.
Address 31\ ..-5^
City: f-CY, State: FL
Zip Code: 3t4c' A Fax:'1'1o7'4b4-a V;J
Phone No. Oh\ti
E-mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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E-Mail:
State or Coun icense: �` 0 Old O 1 C n
R vame or construction is �.zbuu or more, a imcoiiotu Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ENGINEER:
Name: i v
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: o...
Address:
City: rti
Zip:Phone:
ate6 P
City: State:
Zip:: Phone:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone.
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 may7estrict 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 your Notice of Commencement.
Signatur (Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY IF
The or Ding instriiinnent was acknowledged before me
th' `day of 20li by
Commission No.
Revised 07/15/2014
- S
Signature Contractor/License older
STATE F FLORIDA
COUNTY OF
The forg ing instru ent was acknowledged before me
thiday of 20 by
. A ,
(Name of person acknowledging
of
Commission No.
State of
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