HomeMy WebLinkAboutBuilding Permit Application ALLAPPLICABL INFO MW BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I ��
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 4/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED•IMPROVEME'NTLOCATION
Address:
Legal Description: �C'=�`v1 jJ v►
Property Tax ID#: LIM — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK '
CONSTRUCTION INFORMATIOW.
Additional work to be nertormed under tispermit-check a appy:
®HVAC Gas Tank F_]Gas Piping Shutters Q Windows/Doors
Ltjl�ectric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �2 `" Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE CONTRACTOR:.
Name ��� ��zc �, Name:.
Address: s file _ Company:/P PAZ! fi9la;54v. f
'J
City: Stater Address: �119 ./V.D' ? s _
Zip Code: Fax: City: tl/15��► l-�i7 � Stater
Phone No. ��-I1 �.� Zip Code-� �S1 / �i- Fax:
E-Mail: Phone No 7 5- % e-
Fill
e'Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: L
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LkEN 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:
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.
s
_Sign ture 4 Owner/Lessee/Agent Sighatufe of Tactor/License Holder
STATE OF FLORIDA q,�I' STATE OF FLORIDA
COUNTY OFIl1ll�'I IU COUNTY OF I ILQI R�
The Q J Ig instrument was acknowledge fore me The forgoing instru int was acknowledgecLbefore me
this L'J"?ay of 20 by this day of 20 by
1-YJ &VJ drank Frf Qafrtck-
(N a of person knowledging) (Name of p son acknowledging
aw
drank Plad4nick- �
(Signature of Notary Public-State of Florida) (Sig ature of Nota ublic-State of Florida)
Personally Known OR Produc d Identification Personally Known OR Produces jdentification
Type of Identification Produced Type of IdentificationProduced �'
Commission No.EG 0 p33 (Seal) Shirley Wilkins nCommission No.EES (Seal)
Notary Public \\ Shirley Wilkinson
C�
=:�F My commission No.EE 833969 State of Florida
Revised 07/15/2014 '''° F`
""'" Expires:September 10,2016 °F F\°\\ My commission No.EE 83396
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