HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
Date: Per
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:
Address: 00
C!(Gl IQf �C ' r. C
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.Ido
Project Name: 2
Setbacks Front Back4c)IRight Side: Left Side.: F'T
CYC- C1 n& 1_1
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Aciciitio–n--a;17w,'orktobepertormecIunder this permit–check a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _SepticBuilding Height:
Name G n+ ;:Name:..:.:.. ...
Addr 6Y ;Company.
City:�-nr State: Address
Zip Code: �' Fax: City: - State:
Phone No Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
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:
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:
OWNER/CONTRACTOR AFFIDVIT:Application is,hereby made to obtain a permit to do the work and installation as indicated..
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
commencing work or recording our Notice.of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License,Holder
STATE OF FLOIMDA STATE OF FLORIDA
COUNTY OF 1.► ,moo, COUNTY OF
The forgoing ins rument was acknowledged-before me The forgoing instrument was acknowledged before me
this day o 20V� by this day of. .- :20 by
( me of person acknowledging) (Name of person acknowledging)
ignature of Notary Public tate of Florida). (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification : Personally Known OR Produced Identification .
Type of Identi1fi^c`ation Produced Type of Identification Produced
Commission No. "�., (SeOPHAHNAINGRAM ommission No. (Seal)
?r°. ;`�s Notary Public-State of Florida
• My Comm.Expires Dec 20,201
Commission#FF 177249
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