HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (— p Permit Number:
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 here
PROPOSED IMPROVEMENT LOCATION:
Address::-��—V1 C` t -r- � 1G \ C �� 4 :-� ('F:tON.
Legal Description: C—f—A . ti iY �Q + u6,A
Property Tax ID`-1r`�� ��i C�- ��i( i l c7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Hack: Right Side: Left Side:
DETAILED- DESCRIPTION OF WORK:
(�
I CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit—check all apply: r
HVAC Gas Tank 0Gas Piping _ Shutters Windows/Doors
11 Electric Z Plumbing 75prinklers Generator Roof I
Total Sq. Ft of Construction: S Ft. of First Floor: !I
Cost of Construction: $ Q"�r-C' . 0 C� Utilities: Sewer E]Septic Building Height: !
OWNERAESSEE: CONTRAyy��CTOR: �
Name„ ��� �i 1 ( 1 Name: IJG�tl ILi tP4A"-bA ,
Addr s: r� t Y_kt! V �Y-C'tl i ��Company:
City: ir� - 1 StateXT Address: 7SC' z�) rGf jc�Z
Zip Code 4 l=ax:
Phone No._41—��
E -Mail:
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
City: Pc')C;' ,5 i L c<C / State: r �
Zip Code: Fax: Irl � 2 -9 7
Phone No. 7172- Y7,r-
E-Mail:.I Ci'YlCa11�1�1(9 inli Ir(_� G�C� PC1f 1tc!" t CDn
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
UR.PLEMENTAL CQNSTRUCTIdN L l N LAW tNF`ORMATl.ON.
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 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 Horne 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 a first inspection. If you intend to obtain financing, consul I ler4er-" attorney before
co enci r or recordy.Qur Notice of Commencem �.
( _
1 � s
_ Signature of Owner/ Lessee/Agent + Signature of Cont—Filctor/License Holder`'
Ica
47 Q Gt
STATE OF FLORIDA s
COUNTY OF 4e
I
The forgoing instrument was acknowledged before rr ' o _S
this �ti'day of 13C �b P.>� 20 �by � ;
[Name f person acknowlea ing) '
;/ � ..'�� ,mow•
(Signature of Notary Public- State of Florida f
Personally Known
Y OR Produced Identification
Type of Identification Produced
STATE OF FLORID,
COUNTY Of
+c
The forgoing inst mept-was acknowledged before
this day of C)C--'F-� b -e—r . 20 L by S
� f Co.
gz
ID(N) �_At Q'i ry4a z r _
{Name ofd rson acknowledging)
C] f�
gs`�tNvllurp,��
K04,�ignature of N t'6 ary Public_State of Florida j ,���**
rn
Personally Known L, ---6R Produced Identification
Type of Identification Produced
Commission No./�`�`Il'l (Seal) Commission No. 0`�7 �1 "/ (Seal)
Revised 07/15/2014 ,
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