HomeMy WebLinkAboutBuilding Permit Application FO UST E COMPLETED FOR APPLICATION TO BE ACCEPTED I ��
Permit Number:
Building Permit Application
.ring 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
Address: ('((/e4— -P)-erre,
Legal Description: / p�!
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Property Tax ID#: 69 D00!3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIRTION OF WORK r
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CONSTRUCTION INFORMATL0IV '
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Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:
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OWNER%LESSEE F
` CONTRACTOR "' y
Name � Name: -ln- � -���' --
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Fill in fee simple Title Holder on next page(if different E-Mail: e c
from the Owner listed,above) State or County License: S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMERiTAL Ct3NST,RUCTI.ON4 LIEN LAIN iNFC1RMATIQN S:
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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 permitwill authorize the permit holderto 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 aur Lice of Commencement.
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_Signature wner/Lessee/Agent Signature of Con actor/License Holder
STATEFLORIDA STATE OF FLORIDA /� ,.
COUNTY OF_ �' � _ COUNTY OF f7 /-
The f r in instrument s acknowled ed !fore me The far ng instrument wa acknowledge !fore me
this_Xay of� 20�y this way of .4 20 by
(Name of er acknowledge } (Name f r on acknowledging)
(Signature of N tary P c-State of arida) (Signature f No ublic-S to of Florida)
Personal! KnownAZOR Produced Identification Personally Known::
OR Produced Identification
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Type of Identification Prod c 2 of Identification Produced
Commission No. RO}�D FRAMP7flN mission No. ROY 1566 },MPTON
Notary p iW1 State of Florida Notary Public-State of Florida
Commission#FF188186 Commission#FF188186
YCam—ffilswon Explies jam.S.201IQ My Commission Expires Jan.8,2019
Revised 07/15/2014 — —f
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