HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLIC LE IN O UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
JW 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 1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMP
Address
Legal Descr
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
i 14:�,
BYck:
a I LI - --I-
Right Side: Left Side:
Lot No.
Block No.
I
DETAILED DESCRIPTION OF WORK;
't s e- Cr
l w rs its
CONSTRUCTION INFORMATION:
Addi nal work to be ertormed under this permit — check all h apply: I
PHVAC L _J Gas Tank nGas Piping F] Shutters E]Windows/Doors
11 Electric ❑ Plumbing Sprinklers 1:1 Generator 1:1 Roof
Total Sq. Ft of Constructions:
Cost of Construction: $ L/00
SFt. of First Floor:
Utilities:Cn Sewer F]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ' _ f Name: o i
SUPPLEMENTAL CONSTRUCTION 'LIEN LAW tNI=ORMATiaN -
FEE SIMPLE TITLE HOT _TJ Not Applicable BONDING COMPANY: Not Applicable
Name: A 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. LucieCount makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 musl be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, cons with lender or an attorney before
commencing work or recording vour Notice of Commencement.
i s
—Signature wner/ segent Sig ature o ontractor/License Holder
STATE OF FLORIDA/
COUNTY OFD yVl
The forgoing instrument was acknowledg d !fore me
thisOL—Payof20 ,y
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this -20 day oi�(Ile— 20 1\0 by
T�� 1 C�t�iZ> 10'7`gr a.
_ ame rso Howledging)
(Name of pers acknowle ging)
u�e,eP�Votary Public State of Florida) (Signature of Notary Public State of Florida )
Personally Known OR Produced Idepa 'fi ion Personally Known OR Produced Identification
Type of Identification Pro_ e of iuellLiiLaLIL n Produced
,A y,'ti Commission No. _P�IPEREZ
- state,of ilorl mmission No. P"P Rb R+lARRO
CommifeIN 0 FF9#838� ��"� `°�,
_z n€ MY COMMISSION#FF$72714
My Comm. ExpkM Aug 23; 2 20 ` ,(p TES �,.,A� ?829
fit Bonded thr �� 3`
� �efY Nom• � ^�.° �R,..� Bonded through ist State Insurance
Revised 07/15/2014 -
REVIEWS FRONTLZROEVNING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER IEW REVIEW REVIEW REVIEW REVIEW REVIEW
CDATE
OMPLETE
INITIALS I I I I I J