HomeMy WebLinkAboutpermit applicationALL APPLI ABt E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: J Permit Number:
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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: _]4 L:)
Legal Description: 1
Property Tax ID #: 10 .0 Lot No.�
Site Plan Name:i22
, t IL-4, Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additionjal work to bfirtormed under this permit –check a apply: HVAC Gas Tank Gas Piping _Shutters
11 Electric 0 Plumbing Sprinklers F-1 Generator
Total Sq. Ft of Construction: 5q. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer []Septic
Windows/Doors
CQRoof Roof pitch
Building Height:
OWNER/LESSEE:
11Name
CONTRACTOR:
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Name:
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Address; t
Company;. .,
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City; k>-,%C_Q_ State: rd.�
Address:
Zip Code: �J Fax.
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Zip Code:
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Fax
Phone Noa__'.-�ol..
E -Mail: _
Phone ��
E -Mail;
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 KtCUKUtU Notice or commencement is requireu.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: T Not Applicable
Name:
Address:
Address:
City: _ State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: e Not Applicable
Name:Name:
BONDING COMPANY: Not Applicable
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 your Notice of Commencement.
s
_ Signature of Owner/ L e Age t Signature of Contractor/Lidens older
STATE OF FLORI A ,r�1'p STATE OF FLOA
COUNTY OF G' COUNTY OF �—
The f oing ins ument was acknoMedg d before me
this day o �1 20��by
(Name of person acknowledging )
(SignatNre 6f Notary Public -Mate of Florida )
The for oing instru ent was acknowledge before me
this day of �0 by
kA�
(Name of person acknowledging )
(Signa re o otary Public- ate of Florida )
a
Personally Known OR Produced Identification Personally Known ✓OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. :r JOYCEMICHAU oRrR ssion No. r „,
JOYCE MICHAUD
MY COMMISSION # FF M& '*; :•? MY COMMISSION #FPC
� ,.• y Bonded Thru Notary FOR, Underwriters 7 ,� ! "' bonded Tnru fVple,y pubApfi 5.
lic Unc
Revised 07/15/2014
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DATE
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INITIALS