HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _.__a ' I� Permit Number:.
POMIMP
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
PROPOSED IMPROVEMENT LOCATION:
Property Tax ID #: -')(5 ] Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
PAL
onai work to 0jrtormed
unser this
permit — cneCK a
apply:
Address:
HVAC Gas Tank
F]Gas
Piping
Shutters
Windows/Doors
Electric ❑ Plumbing
Zip Code: Fax:
Sprinklers
a Generator
Lei Roof
Total Sq. Ft of Construction: y�
Cost of Construction: $ ll'' "`F�3.�. c
S Ft. of First Floor: _
Utilities: n
Sewer LJ Septic
Building Height:
OWNER/LESSEE: '
CONTRACTOR:
Name Lc.�+c�.T_
Name: S
Address:
Company:
City: State:
Address: 1J ' �,
Zip Code: Fax:
City i_7 State:
Phone No,
Zip Code: Fax:
E -Mail:
Phone No.��--
E -Mail: S.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: i 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
commencinR work or recording your Notice of Commencement.
s
_ Signature of Owner/ L e Age t Signature of Contractor, older
STATE OF FLORI A G STATE OF FLO A
COUNTY OF COUNTY OF �'
The f ping instrument was acknowledged before me The forgoing inst ument was acknowledged before me
� �by day iaY�� 20 � by
this day of 20 this � of
(Name of person acknowledging) (Name of person acknowledging )
(Sign tur of Notary Pu ic- State of Florida) (Signatu of Notary Public State of Florida )
Personally Known L-' 1. OR Produced Identification Personally Known L--'OR Produced Identification
Type of Identification Produced Type of Identification Produced
�
Commission Nov �ll toion NJ
JOYCE IAICH
:3: MY COMMISSION i! F 083CD6c s JOYCE MICHAUD
MY Cowissi
°,?E
• IRE$: APriI ^c5, 2018
Bonded Thru Notary Public Underwriters
Bonded Thru Notary N&Po r r dr d
r lnrs
Revised 07/15/2014
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