HomeMy WebLinkAboutBuilding Permit Application -7'1
ALL APPLICA LE INFO MUST.BE 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: To Select from dropbox, click arrow at the end of line
PROPOSED IIVIPROVEIVIENT,I.00ATION J e
Address: kc _ V
Legal Description:k,
Property Tax ID#:y��.�— r. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTION INFORMATION.-
Additional work to be nertormed under tis permit–check all appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric umbing ❑Sprinklers ❑Generator 1:1 Roof
Total Sq. Ft of Construction: I�1 S Ft.of First Floor:
Cost of Construction:$ Ll Ol��� Utilities:DSewer❑Septic Building Height:
OWNER/LESSEE .CONTRACTOR = ,+
Name Name- 'Robe c`\ Ut,&k%.L M
Address: ompany:
City. State: Tr Address:`
Zip Code• 9� Fax: City State:
Phone No:1);I_,':X96 MW Zip Code: O,Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail Yti
from the Owner listed above) State or County icense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENT,ALxCONSTRU'CTIO.N LI'EN3 LAIN 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
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,consul ith lender or an attorney before
commencingwork or recordingour Notice of Commencement.
�f`—�'—a/ 1 / S
_Signature of Owner/Lessee/Agent nat e C tra or/License older
STATE OF FLORI & STA OF FLORIDA
COUNTY OF COUNTY OF �Sk
The f going instrument was�cknowledged,before me The forgoing instr nt w s acknowledged before me
this�day of ��UJ — 20 `6 by this�ay of 20 Lf by
(Name f p rso acknowledgi - (Name of person acknowledging)
(Signature of Notary Public tate of ri 0,� ,p (Signature of Notary Pu c-State o Florida)
Personally Known OR Produced Personally Known OR Produced Identification
Type of Identification Produced ti Type of Identification Produced
Commission No. (Seal) $ate?� Commissio .,c
4y� a . RHONDA L.AFFERTY
% MY CQ MISSION 0 FF=R549A7
Revised 07/15/2014 EXPIRES January 08,2017
(407)398.0153 FftdallotaryService.com
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