HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r j
Date: Permit Number:
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
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Property Tax ID#: .tel' d� j! — Lot No. /
Site Plan Name: Block No.
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Additional wor to nGasTank
orme un er t is permit-c ec a appy:
❑HVAC'. ❑Gas Pipin _Shutters l Windows/Doors'g
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11 Elect ric OPlumbing Sprinklers 11GeneratorI.�Roof
Total Sq. Ft of Construction. A S .Ft.of First Floor: C3 C)Cost of Construction:$ �. D� Utilities:]Sewer Septic Building.Height:
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Name 7 000$fJna Name, .
Address. Company:
City: A State. Addre
Zip C e: (q S`_] Fax: City: 2� State.
Phone No.q119 9 �f'i- 1Zip Code: �1c�2��i x2-��3"'��`r]
E-Mail: Phone No.-) 3-1 56
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Fill in fee simple Title Holder on next page(if different E-Mail: ( m
from the Owner listed above) State or County License.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: a
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:
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 Notic f Commencement may result you�ed
mg twice for
improvements to your property.A Notice of C encement must be recorded and on the jobsite
before the first inspection. If you intend tain financing,consult with I attorney before
commencing work or reMrding yoypWtic of Commencement.
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_Signatur of esse /Ag Signature of icense HoldeL
STATE OF FLOR STATE OF FLORI
COUNTY OF COUNTY OFA
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The Ing Inst m nt was act �owledg before me The f rgoing instr ent was a 1<nowledg d before me
this,v of O��by thi�y of 20 by
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(Nam per acknowledging) (N of p son a nowledging)
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( Ignature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally KnownOR Produced Identification Personally Known OR Produced Identification
Type of Identificati Producedype of Identifica on Produced
Commission No. ,,,���� (SeQREISS SCHWAB ommission No.
"� eSHREISS SCHWAB
Notary Public-State of Florid �� ,
�+ 427 :�sPtiv P�A�''% r-State of Florida
2019 a ° + ,'
Revised 07/15/2014 '}"'� Q' Comm.Exp►res Mar 3. (I Commission# FF 2054212019 ,
°��,°�f���`._. _ -` ,� ',�y� e,� Comm.ExplreS Mar 3,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE i
INITIALS