HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN O MUST PE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —���� t 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 t�
PERMIT APPLICATION FOR:
PROPOSED IM.PROVEMERI ",LO:CATIt3N
Address: -P+
Legal Description:
Property Tax ID#: °Akzs cLot No. 2A-
Site
-Site Pian Name: Block No. �1
Project Name: ))��.,,
Setbacks Front — Back:^�_Right Side: JJQ,ea Left Side:
DETAILEDDESCRIP TION;OF WC?RK
CONSTRUCTION INFORMAl"ION:
Additionalwork to be performed under this permit-check all that appy:
_ HVAC _,Gas Tank `Gas Piping Shutters `Windows/Doors
Je-Electric `Plumbing ^Sprinklers Generator Roof
Total Sq. Ft of Construction; 4 _- Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: ,Sewer _Septic Building Height: t �T
OUVNER`.LESSEE: .CONTRACTOR.:
Name t - t Name, p�� ova V.41.P '
Addres
�� �. �° Company:
State r. Address:
Zip Code: Fax:"I"1 A(,L--+,- l llue City: State:
Phone No. -11 Z- Zip Code: Fax:
E-Mail: c'
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$2540 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTION LIEW 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
comr1ekinwWork or recoMing your Notice of Commencement.
S
_Signature of Nwner/-Lessee/Agent Signature of Contractor/License Holder
STATE OF t I STATE OF
COUNTY OF FLORIDA � /--UQ k-Q_ COUNTY OF FLORIDA
The oin gL instru t was acknowledges ore me The forgoing instrument was acknowledged before me
thisa of . 20 this day
of 20 b
(Name of person acknowledging) (Name of person acknowledging)
l
(Signature of Nota f arida) (Signature of Notary Public-State of Florida)
,,'O\\Il Irl P,i�'� Y IVG �
SPR' (r
Personally Known :? I ti t AF Personally Known OR Produced Identification
Type of Identification i5q •�— - rate of orida Type of Identification Produced
���\\\\ Expires May 27,2019
Commission No. Wationattiiotai Commission No. (Seal)
Y Assn.
Revised 07/15/2014
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