HomeMy WebLinkAboutBuilding Permit Application PALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: /SO&) -
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
PROPQSEDIN(PROVEMENT LOCATION
Address: 5�. b
Legal Description: — ,
Property Tax ID#: Lot No.
Site Plan Name: \— Block No.
Project Name:; (, tr\
Setbacks ' Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK ` `
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P"EP)_AcF_ -Sin1l r HIGS -IJP oU LE'S !�l SII 13 ifs
xCONSTRUCTION--INFORMATION �s
Additional work toe e orme under this permit—c ec a appy:
-4VAC Ei Gas Tank ❑Gas Piping _Shutters Windows/Doors
ectric ElPlumbingSprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �S D Utilities:]Sewer E]Septic Building Height:
w
AEF CONTRACTOR M "a
Name Name:
Address: Company:
City: State- Address:
Zip Code: Fax: City. State:__1_�—
Phone No. Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: e
J
from the Owner listed above) State or County License:
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 BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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/Agent -Signature of Contractor/License Holder
STATE OF FL
STATE OF COUNTY OF ORIDA C� ,Gy, { COUNTY OF ORIDj���
The for ing instru nt was acknowledge b fore me The for oing instru was-acknowledged before me
this day of 20 �by this day of 20 by
(Name of p n a knowledgi ir.. (Name of on ac nowledging) •'�:" ;r•,
(Signature of Notary Publi Stat f Fl (Signature o Notary Public-S ate of FI a P y
Personally Known OR Produ I It Personally Known OR Produced I i
Type of Identification Produced Type of Identification Produced
Commission No. (SeOC��F��' Commission No. (Seal 0
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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