HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST 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) 462-1553Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrowlat the end of line
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Legal Description: GL
Property Tax ID#: 3 yZ f!L'f`y CSO Q coo 0 I Lot No.
Site Plan Name: / Block No.
Project(Name: /Z�GS! nom'
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to {{en�e( med under this permit—check a appy:
F]HVAC Ll Gas Tank. F]Gas Piping _Shutters windows/Doors
Electric F Plumbing Sprinklers Generator Roof1i1
Total Sq. Ft of Construction: 10
S�Ft,(of First Floor:
Cost of Construction: $ '. Utilities: L=1 Sewer Septic Building Height:
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Name .. T G la !7
Address: e— Company: C l" l n:i f'i
City:Ad j'I(moi State: A Address: E
Zip Code: ,,�1_9ax: City: ME State:
Phone N((1,72 3 qv— � �t�' Zip Code: ,3(JC � Fax:
E-Mail:_ Phone No.S'a_S'
Fill in.fee simple Title Holder on next page( if different E-Mail: , 06 0 cc, d I
from the Owner listed above) State or County License: �
If value of construction is$2500 or'more,a RECORDED Notice of Commencement is required, i
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION':
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: ! State:
Zip: Phone: Zip: Phone: 1
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder;to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender o I an attorney before
commencing work or recording our Notice of Commencement.
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_$il gnature of'Owner/Lessee `(g� Signature of Contractor'Lice a older r
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STATE OF FLORID STATE OF FLORID, '
COUNTY OF �� . ��Ll•Ci COUNTY OF Ot , G I Ci(.Qi
The forPPQ�ing instrume t as ac//kfiPowledged before me The forgoing instrument was acknowledged before me
this !?!'?ay of 20 8&Qby this/1 "day of 20 J(,o by
(Name of person acknowledg' ) (Name of person acknowledging
JW '(J N
(Signature of Notary Public-State of Florida) (Signature o Notary Public-State of Florida)
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Personally Known OR Produced Identification Personally Known _J" od c I e t i a
Type of Identifica o Type of Identification Pr
"'� Notary Public State of IoF rlde
. Davis
JennN6Wffer Davi a e a a < < My Commission FF 988028
Commission No. omMISMa4w. Commission No. an ExPlra45&24)2020
or ExPtrea 02!29/2020
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW I REVIEW REVIEW
DATE
COMPLETE
INITIALS
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