HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: I .y 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:
PROPOSED IMPROVEMENT LOCATION:
Address: 1701
Legal Description:
Property Tax ID#: � a �� dr � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Sider Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that appy:
HVAC _Gas Tank _Gas Piping _Shutters Windows/Doors
V//Electric _Plumbing Sprinklers _Generatory _Roof.
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ y�'�'� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name A�A p5c"r IrA6 Name: s
Address: 9S� StiJ ri h` C�U !' II Company: r�11 f*AP
City: G L State: 'L Address: 7Z�
Zip Code: Fax: City: State:
Phone No. Zip Code: 3`1 Fax:
E-Mail: Phone No. 16772 //"
Fill in fee simple Title Holder on next page(if different E-Mail: y�"Cehl��(�0 Ib 1.ZOA
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN 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 OW ER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements t y ur property. A Notice.of Commencement must be reco d and posted on the jobsite
before tw firs to ection. If you intend to obtain financing, cons.0 t with I n er or an attorney before
coM4eqqing or, recording your Notice of Comm encem t.
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_ gnature O ner%Lessee/Agent eatureC tractor/License Holder
ATE OF FLORID► / ORI,9�
COUNTY OF1 COUNTY OF_GlrZ�
The foygoing instru ent was acknowledge4lie"fore me The for ing instrumen was acknowledged before me
this day of 20((Sby this 7day of � 20j by
(Name o erson acknowledging) (Na6e of person acknowledging)
(Signature of Notary Public-St to of Florida) (Signa u e of NotaryPublic-State4offlolri�d�a)�
Personally Known OR P.�r�. d de.tifca 'onl Personally Known OR Produ ed Identification
Type of Identification P,r. �3Ued N€ Type of Identification-Prod;
IT � PRY P�e�
_° Notary Public-State of Florida I °» y`� Newry Pup c- tate of Florida
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DATE
COMPLETE
INITIALS