HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i Permit Number: _
on
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
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: C l_ 1L.—Una Il
Property Tax ID #: { CA ISA C(.3 1 - 0 t(zcl 'a)Q' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front _ Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�v—
CONSTRUCTION INFORMATION:
Additional work to bffOrme un er i is permit — check a apply:
Piping ❑ Windows/Doors
HVAC Gas Tank Gas _Shutters
LJ Electric ❑ Plumbing Sprinklers ❑ Generator Roof
Total Sq. Ft of Construction: SgFt.. of First Floor:
A Utilities: I Sewer E Septic Building Height:
Cost of Construction: $ .� �I
OWNERAESSEE:
CONTRACTOR:
Name S
Addre s:
Name:
Company:��
City: State:
Address:�. `--
Zip Code: Fax:
city:tir �S-ttattre:D
� r
Zip Code: � Fax
Phone No. f,
,t�'`-�
E-Mail:
Phone Na
E-Mail: S,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County license:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City:— State:
Zip; Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY
Name:
Address:
Citv:
Zip: Phone:
T Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 before
commencing work or recording your Notice of Commencement.
5
_ Signature of Owner/ L e Age t ,' Signature of Contractor/Lrcens older
STATE OF FLORI A STATE OF FLO A
COUNTY OF COUNTY OF
The for oing instr ent wars acknowledge before me The forgoing instru ent was acvnowledge before me
this lay of �20 Wy this —& day of 20 46> by
(Name of person acknowledging) (Name of person acknowledging )
IAC..-.-- - -•
(Sign reef Notary Public`�State of Florida )
Personally Known (__ OR Produced Identification
Type of Identification Prroduced��1
Commission No. FV O 6ZO (Seal) 4
JOYCE MICHAUD
Revised 07/ 15/2014 X: EXPIRES: April 25, 2018
•f;ud ��;. Bonded Thru Notary Public Undervdders
4
(Signa re f Notary Public tate of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
al)
EXPIRES: April 21N. AN FF 08Z
Bonded Thru Notary Pu hli 1�4 Fs^ u 2$, 2018
3;nde 'Alz undewrt
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