HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C
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: To Select from dropbox, click arrow at the end of line
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Legal Description: 1000/ 19 Al !/ Gtech br i cr (4d V/ ��a-0
Property Tax ID#: 33.7.2' 700 - O/D/ - m�3- Lot No. '9 4 _
Site Plan Name: Block No.
Project Name: ,
Setbacks Front Back: Right Side: Left Side:
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check all that
� appy:
aHVAC Gas Tank ❑Gas Piping X Shutters Windows/Doors
Electric Plumbing Sprinklers El Generator El Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �o�D ��. 17 Utilities:,n Sewer Septic Building Height:
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f�5;�Name
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Name
Address: " a C Company: �`
City: 19 es, State: G Address: o�3�S
Zip Code: L Fax: City: State
Phone No. - L 1 X00 Zip Code: 3 Fax: 7
E-Mail: Phone No. 2 �w_ �
Fill in fee simple Title Holder on next page(if different E-Mail: I& _amAr Ve 0,v.G'd
from the Owner listed above) State or County License: 4e
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: 11
Address: Address:
City: IV I rl State:T City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: A Name:
Address: Address:
City: V City:
Zip: Phone: Zip: Ph ne:
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
commencinR work or recording our Notice of Commencement.
ignature of Owner Agent/Lessee ignaturd of Contractor/License Holder
STATE OF FLORIDAa� ��� STATE OF FLORIDA
COUNTY OF y SCJ �� Q COUNTY OFA_
The fo ing inst�r e^nt was acknowledged before me The forgoing instrument was acknowledged before me
this day of �Y ( 20 Eby this c:P-1 day of av 20 y
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub* -Stat of .lorida) (Signature of Notary Public tate lorida)
PersonallyKnown y ,,,�� p
.tacked Iden TT""''i Personally Known aY Produced Qf1ti�tdBn
Notary ub is to da o d; `t f
Type of Identification Pro '` Type of Identificatio �' Notary Rublic;State of Florida '
y t:ontrtr-Exp(res har ,full l =•. :My Comm.Expires Mar 22,2017
9; ,, om�{isston,:#�::EE 877571 ;; `� Commisf, J.)EE 877571
Commission No.. . •,FOFF��.• Commission No. E o�•�'
'8oi ��hfough National Notary Assn. Bonded Through National Notary Assn.
Revised 07/15/2014.
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