HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABE INFO U BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
UPermit Number:
9
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 X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRO`P,OSED IMPROVEMENT#LO.CATIQIV. s `,
Address: S
tAiA
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
'p
'DETAILED DESCRIPTION O.F:WORK.
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CONSTRUCTIp.N INFORMATION r:
: .,.
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Additional work to be nerformed under t ispermit—check all appy:
HVAC Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
'4Electric Plumbing U Sprinklers ElGenerator E] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ y`JcS� Utilities: Sewer Septic Building Height:
3
OWNER/LESSEE C
ONTRACTOR
Name Name:
Address: -J _S Company: C_
City: L State: A Address: f
Zip Code: ��GJ"Z Fax: City: Sta e:
Phone No. Zip Code: dl�Z Fax:—n?? -t(-P(-
E-Mail: Phone No. —
Fill in fee simple Title Holder on next page(if different E-Mail: _ S
from the Owner listed above) State or County License: �� .1�(>l� ` lcu'�>
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
r •SUPPLEMENTAL,CONSTRUCTION LIEN LAW INFORMATION:
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:
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 before
commencing work or recording our Notice of Commencement.
s
Signatur Owner/Le a Co tr for as Agent for Owner Signatu"OF11
antractor/License Holder
STATE OF RIDA STATE RIDA h
COUNTY OF SCJ�� COUNTY OF
o
The f r Ing instrum nt was acknowledged fore me The for oing instrume' t was acknowled �(d efore me
this day of 20 l nby this�day of 20 1_ i by
( a e of person acknowledging) (Name of person acknowledging)
SAHY '
(Signature of No ry Public-State of Florida) (Signature of N-t Public-•t�4Kori a
�, �1' Id
NOfar GFA
e sonally Known tJRaP a Id ntification Personally Known OR'P � Idgif�cthon til y_ UFF
1 Up FLUa�� nll J dl�-
T e of Identification Pro uced'�-1111 ` ��� s� ate of
Type of Identificatio dUo vi F p o°dedthro E01resM 1234j3 p°a
Notary Public-
State of Florida Commission No. Natioq�ay27 201
Commission No. "Y: O� on #FF 234730 aryAssn9
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My Comm.Expires May 27,2019
Pnml.ri thr
- Y ssn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS