HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: fro Permit Number:
.; RECEII .__ l ;J1 18 2616
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 kA
PERMIT APPLICATION FOR: Q
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'PROPOSED INPROVE °LOCATION r
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Address:
Legal Description:
Property Tax ID#:(:J 3,509- —7—000 g Lot No.
Site Plan Name: Block No.
Project Name: �.1; 1QX1 wew �S
Setbacks Front Back: Right Side: Left Side: p
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�DETA�LEDDESC IPTION OIF'WORK a, �� ; ,�f w � a
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�CONSTRIJCTIONINFORMATION r ,
Additional wor to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers Generator _Roof
Total Sq. Ft of Construction: - '� Sq. Ft. of First Floor:
Cost of Construction: $ Am M Utilities: —Sewer _Septic Building Height:
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OWNER LESSE "�MUM� �X RcKX43 4 � ' ' CONTRACT RKM ;
Name Name:
Address: 1/9D 3 /tg ,44- hr Company:
City: F11 A—ete-.e, Stater Address:
Zip Code: -3'Y'?,?
� Fax: City: State:
Phone No. - �r - 6(W-// Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S&P'PLEMENTAL CONSl"RIIJCTION LIEN LAV1/ CNF®RM'ATi®N;
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:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 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:=