HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: q 1�� 1 `� Permit Number:
J
•
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
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: I Lot No. a
Site Plan Name: l Block No. (9J
Project Name: ^ (�■�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
Poi
CONSTRUCTION INFORMATION:
CONTRACTOR:
Name
itio wor to a er orme un ert is permit— check
a appy:
Company.
Add ress: �-
HVAC Gas Tank
[]Gas Piping
_Shutters
E Windows/Doors
Electric Plumbing
Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction: SQ. Ft. of First Floor:
J0utilities:0 D
E -Mail:
Cost of Construction: $
from the Owner listed above)
Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
s �1J: �•�
Company.
Add ress: �-
vYCa
Address:sta*f HCl �v
City: �C • C� fit- State:
Zip Code: Fax:
City: wi,�``�
Stater'(-
Phone No. 7- •bC
,
Zip Code:'--:c��'l�eCi
Phone r4o,
E -Mail: —
Faxc''�t`
_ t�2+l+riC.a•LY
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:��1�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTfON LIEN LAW INFORMATION:.
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:_
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
State:
_Not Applicable
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/ Lis a Age t Signature of Contractor/ older
f
STATE OF FLORI A STATE OF FLO A
COUNTY OF COUNTY OF
TheL ing instrument was acknowledge before me
this day of 20 LVby
(Name of person acknowledging)
(Signa re otary Publ%-,,,State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission No. SFA 3O&
Revised 07/15/2014
The forgoing instru ent w s acknowledge diibefore me
this day of 20 by
(Name of person acknowledging )
(Signat Nbtary Public- ate of Florida )
Personally Known L ---'OR Produced Identification
Type of Identification Produced
mission No. FF
EXPIRES: April 25, 2018
Bonded Thru Notary Public Underwriters
JOYCE MICHALID
EXPIRES: April 25, 2018
Bonded Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS