HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: " y
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 linee�,'�D
PR.OPOSED'IMPROVEMENT�LOCATION
Address:
Legal Description: C4 10�1 ' 214
Property Tax ID#: o 1 Lot No.
Site Plan Name: Block No.
Project Name: .
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONbF WORK1
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741-2-
CONSTRUCTION INFORMATION #;
Additional work toe e orme under this permit-check a appy:
E1HVAC E]Gas Tank ❑Gas Piping Shutters_ (� /Doors
I_l Windows
Electric ❑ Plumbing Sprinklers E Generator .Roof
Total Sq. Ft of Construction. _ Sq. Ft.of First Floor:
Cost of Construction. Utilities: Sewer Septic Building.Height:
OWIER LESSEE: CONT ACTOR: '
.Name Name
Add r s: (� V Company:
City:C State:_ Addre
Zip Code��((Cl., 1 Fax: City: � State.
Phone No. I-)32.—1 � _J l O Zip Code: ;21C q N l� ' Tlx.72-,-
E-Mail: Phone No.7T - 93—)"Sb S
Fill in fee simple Title Holder on next page(if different E-Mail: .l 0 ( ✓n
from the Owner listed above) State or County License: ` �'1�1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEfVIENTpL�CONSTRUCTION LIEN�LAW _'INFO ATIdN _�
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 respect's,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 co our Notice of Co cement.
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_Signatu, of Owne a erernt Signa icense;HoLder
STATE RI STATE OF FLOR
COUNTY OF COUNTY OF
Th"oing instr rr ent w s nowledge efore me The for oing inst
ackrwas cknowledg d before me
this day of 20 y th day of
rept 1&k__,20 by
i
(Na of erson acknowledging) (Na e f son ackncwle
:lad
(Signature o Notary P 'c-State of Florida) (Signature of Notary Public-State of Florida.)
Personally Know Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identifica n Produced
Commission No. „�e„ LC I Co mis ori, o. SHREISS SCHWAS
R SHa s�}jCIiWAB ,os5;s Pu ac��a
Notary Public State o1 Flonda :_ A Notary Public State of Florid al
sion#FF 205427
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N, Tres Mar 3,2019 �,� P=` M Comm•Expires a
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Revised 07/15/2uyg y
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS