HomeMy WebLinkAboutBuilding Permit Application All APPLICCAAB E INFr MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: - 1 Permit Number:
x.
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:
PROPOSED INPRq�UfMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: e .J D(o(f2 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AILED ► E�SCRIPTION ®' WO' dK:
exSPIN
w ago
=@%T1N NFORMATION:
Additional work to be pertormed under this permit—Check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�O
Cost of Construction: $ =0 go Utilities;.._,-,—Sewer Septic Building Height:
01NN R/ E�SSEE. C�O.NTR ®�
NameAt—
Addr sS � Company:
City: State: Address:
Zip Code: Fax: City: State:
Phone No. 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 Lice
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
#� �PPLEM'ENTAL CONSTRU Tt®N LIEN .LAW INFt?'RMATION.:
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=ion
rtNotice of Commencement must be recorded and posted on the jobsite
before Irst u intend to obtain financing, consult with lender or an attorney before
o encin wour Notice of Commencement.
Si ature o7FL
er es /Cont or as Agent for Owner Signature of Contractor/License Holder
STATE OFRIDA STATE OF FLORIDA
COUNTY ���UQ— COUNTY OF
The f oing instr rite t as acknowledge before me The forgoing instrument was acknowledged before me
thi fir- day of 20�p by this day of ,20_ by
(Name of person acknowledgin ) (Name of person acknowledging)
(Signature of Notary blic-State of Florida) (Signature of Notary Public-State of Florida )
Personally Kno ;Rro uced IdenKdiwAcrmHlfF ersonally Known OR Produced Identification
`,:�P0.Y PVe�/��,
Type of Identif ca ion r N a� bttC State of Flo d.a ype of Identification
Produced •* :•_ Co ion`#FF��7� roduced
%"ry P My Comm.mmx�pires May,
F
Commission No. �F�Q•�
Bo oughNational Notary Ass . ommission No. Seal
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.