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)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED._IMPROVEMENTLO.CATIO.N, �
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Address: 1
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Legal Description: '��—
Property Tax ID#: �C / J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK
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CONSTRU.CTIOIV„INFORMATIONs� , 'la
Additional work toe e orme under this permit—check a apply:--
HVAC Ei Gas Tank E]Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers I Generator E] Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities:Sewer Septic Building Height:
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OWNER%LESSEE CONTRACTOR` xr ;
Name Name:
Address: Company.
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City:- State. Address v
Zip Code: Fax: City:
c State:
Phone No. Zip Code: c3 Fax: r
E-Mail: Phone Ant
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Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State onse: ;7-
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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1 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 respei ts,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 work or rec9i;ding your Notice of Commencement.
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_Signatur Owner/Lessee/Agent Signature of ntr or/Lic nse Holder
STATE OF FLORIDA , STATE OF FLO�RkDA ,.
COUNTY OF -5kJJC.IQ COUNTY OF `moi-, U�
The forgoing instrument w s acknowledged before e cc v The forgoing instrument was acknowledged before me
this day of rt 20� o�by a m N this a3day of �QrU 1 20 1�by o N
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(Name of person acknowledging) c .N (Name f person acknowledging) c= d
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(SigrilfbiUf Wotary Public-State of Florida) @J®uC (Signatu f Notary Public-State of Florida) Q�U�
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Personally Known OR Produced Identifica iorX Personally Known OR Produced Identificati
Type of Identification Produced 10 Type of Identification Produced
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Commission No. f F lqq 13SS (Seal) Commission No. � ��5� (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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