HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: f 11 (�, -. pR M.�_
Building Permit Application PERS -filrTIr�ie
Planning and Development Services
Si. Lucie County, FL
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 •C L
PROPOSED-IMPROVEMENT LOCATION:
Address:UR "LA %X
Legal Description.
Property Tax ID#: Lot No.
Site Plan Name: o Block No.
Project Name: `
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF-WORK:
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CON4STRUCTION INFORMATION:
Additional work to be nertormed under t ispermit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
�P lectric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
r _
Cost of Construction:$ `;(2O Utilities:0_Sewer Septic Building Height:
OWNER/LESSEE: ` CONTRACTOR:
Name Name: (0._,
Ad s: A U 'y Company:
City 1 State: FL Address: �
Zip Code: Fax: ,l' City: State: L
Phone No.�21—<A 5!�l Zip Code: Fax:
E-Mail:(� CA@ A �a S\fa ,3 Phone No. -
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: aj
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:EN 'CONSTR�U',CTION LIEN
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DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: of 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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants 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 work or recording your Notice of Commencement. 17 X7
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Signature of Owner/Lessee/Agent SignatLrre of Con or/License Holder
STATE OF FLORIDASTATE OF FLORIDA
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COUNTY OF COUNTY OF
The fArgoing instrp nt was acknowledge g before me The forgoing instr nt was acknowledged before me
20 UT
this day of J by this 0?� day of e-gl= 20 by
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(Name of%c n
- In c nowledging) (Name of person acknoeedging)
(Signature of NotaryPub!11cL-Staf4 of Florida) (Signature of Notary Public-Siffbe of Florida
Personally Known d Identification
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Z' (��' Personally Known (�7\ OR Produced Identification
Type of Identification Pr,d 'c Type of Identification Produced
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DATE
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INITIALS