HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:
PROPOSED INPROVEMENT LOCATION:
Address: v s f
Legal Description:
Property Tax ID#: 6 -- ��t \ - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAI,LED`DESCRIPTION OF-WORK: '
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CONSTRUCTION INFORMATION:_
Additional work to be performed un er t is permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 0 - Sq. Ft. of First Floor: /e ,,4
Cost of Construction: $�?(,fit, Utilities: —Sewer _Septic Building Height:
:OWNER/LESSEE. °'CONTRACTOR:,
NameAgo" Name:
Address: -7U1 N, M �`/ . Stet Company: "'
r. r jo�i.Yro 4112 -
City: U�,2 j f"�GL /� State:�� Address: � Cs'�E�. 'rr� iit-0 u!
Zip Code: 3 y 1 D Fax: City:
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Phone No. �s /�`�--(��jy� Zip Code:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail �d�/b�iih/�i/J,fj
from the Owner listed above) State or County License O-C-&
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5U'PPLEIVIENTALCONSTRUCT1ON.rLIEN LAIN INFORIVI'ATIC3N�
/, MORTGAGE 1
DESIGNER ENGINEER: f _Not Applicable 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:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 wor or recording our Notice of Commencement.
Signature otF
r/Lessee/Agent Signature of Contractor/License Holder
STATE OFRIDA STATE OF FLORIDA
COUNTY L COUNTY OF
The o'ng instrurnent was acknodwledg efore me The forgoing instrument was acknowledged before me
thisay of 20y this day of ,20_ by
(N e o person acknowle ging) (Name of person acknowledging)
(Signature of No ar Public-State of Florida (Signature of Notary Public-State of Florida )
Personally Known OR Pro ced Identification Personally Known OR Produced Identification
ion Type of Identification
Produced Produced
Commissi °• ANG LA M H " Commission No. (Seal)
_'• ' = ery P°b)k-State OfS. Flor
commis ion (da
'••.,,;;;�``' °mm• xpehl 7,20Ass
1GERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIE tWhabit&{
COUNTE REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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