HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01 $ N5 Permit Number: \SO -0 t a$
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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 ',1e.-i- 6
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Address: 3�
Legal Description:
Property Tax ID#: �`1y�- ���' � �`c- —� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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EzTA1LEDDESCRIPTION
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RCO;NS�TR CTIOfINFORMATION, '
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itional work toe nertormed un er t is permit-check all appy:
❑HVAC 0 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
YElectric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $4 �� Utilities: (L��Sewer❑Septic Building Height:
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OWN EgR�LESSEE{fi., '. CIJTRACTOR
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Name WSOV'-\ Name: . e -
Address: Company: C_
City: State: Address: ALO
Zip Code: Fax: City: Q State:
Phone No. Zip Code:SLR Cz Fax _ gus
E-Mail: Phone N
Fill in fee simple Title Holder on next page(if different E-Mail: Cc c7'Y�
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:
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 thepermit 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
commencin work or recording our Notice of Commencement.
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—Signa"re Owner essee g t Sig a e of Contracto /Li ense Holder
STATE OF FLORIDA\ 1 n ,� STATE FLORIDA
COUNTY OF 7� W�CA.Q_ COUNTY OF ��C Vex
Th r oin instr ent as ac owled a efore me The or oing in rume t was acknowledged before me
thisday of d 20\ by thi�day of ,20 a by
(Name of person acknowledging) (Name of person acknowledging)
r c� mr
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identificatio-n7 Produced
Commission No. mission Ni. 1.�L _
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:N '� !my Comm.EWNa Nay a1,2019
P�`� My Comm.Expires May 31,2019 ••';F����,�d ',
Revised 07/15/2014 Bonded through National Notary Assn
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