HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB E INFO UST E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. Permit Number:
----- - Building Permit Application
Planning and Development Services
Building and Code Regulation Division
-2300 Virginia Avenue,Fort Pierce'FL 34982'
Phone:(772)462-1553 -Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:-
Address: �461k�j P'bY `3�• LU62
1r t-- 34 5 5Z
Legal Description:
Property Tax ID#: 0� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that appy:
_HVAC _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers Generator _Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Const ruct �[on:$ 7 oo U.tilities: _Sewer _Septic Building Height:
OWNER/LESSEE: - CONTRACTQR':
Name Name:
Address 3/ (/e—
City: 2,YA , UG e State: L Address: -
Zip Code: 3y9f_2_ Fax: City: `r; State:
Phone No. Zip Code:
,E-Mail: �f'�f�,;�t� (�_di/�2�1� GOI�� Phone No.
Fill in fee simple Title Holder on next page{if different E-Mail:
from the Owner listed above) State County License:
If value of construction is$2500 or more,a RECORDED Notice of I lornmencement 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 BONDING COMPANY: _Not Applicable
Name: 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 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
improve ments_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.
s
_Signature of Owner essee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S� J. ,Q. COUNTY OF
.The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of /Agc 4, 20 Lby this_day of 20 _by
19
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary.Public-State of;Florida)
Personally Known OR Produced Identificatl�.6n Personally Known OR Produced Identification
Type of Identification Produced - Type of Identification Produced
Commission No. ssion No. (Seal)
o.uq,9LASHAHNA`INdAA
.�`<►3tr n� �.
Notary Public•Stalo of 1100
-'�'� n•• .• My Comm.Expirpo Cpc 29,`20'
Revised 07/I5/2014 '.;;,r ae;= CommiSSion N Fr
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Bonded
'REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW- 'REVIEW REVIEW REVIEW'
DATE
COMPLETE
INITIALS