HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � �
Date: 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:
PR,O,�POSED IN'PROUEME'NT OCATION:
Address:
Legal Description: Cel
r
Property Tax ID#: ` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AILED ®L SRIPl"IQN O OR
>� /
CONSTRUCTI':0 I NF=WATIQ
'N'
itiona worktobepertormed un er t is permit-check all that apply: .
echanical _Gas Tank _Gas Piping _Shutters _Windows/Doors'
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
ost of Construction: $ � � > Utilities: —Sewer —Septic Building Height:
OW �ER/ E�SSf CONTRACTOR:
Name 012, ycL�'p/G Name: D -rs
Address: a- Company: 2_/ /�7
City: J���` State:_ Address: or—
Zip,Code• Fax: City: ,OSG State:
Phone No. Zip Code: 4`3 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail wry, tel//
from the Owner listed above) State or Count License-'
2
If-value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S�UP'PLB BNTAL CONSI'RlJ'CTI®N LIENLAW IN10,0 IATION:
�\'DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: Not Applicable
r. —
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 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.
Signature of Owner/Lessee/Contractor as Agent for O ner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA `
COUNTY OF
S,�,_�_
(X-11e COUNTY OF LUCA -
The for o'ng instr ent was cknowledg efore me The f r oing instr ent as acknowledg efore me
this day of 20Jpby this�day of 20 by
(Name of person acknowledging) (Nfa rWof pers5c,n acknowledging)
(Signature of ta y Public-State of Florida (Signature o otary Public-S
otate of Florida) /
Personally Known OR Produced Identification Personally Known OR Produced Identification
y
Type of Identifica Type of Iden '
Produced Produced
'• Notary Public-State of Florid FCA
Notar Public M FF
Commissioy� 3 commission#FF 51 Commis ion No. ='F `op.' comm; l'of ��
234��E ) •.,,����„�. Comm ssiod #FF23 Florida
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