HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 arrow at the end of line
I?Rt P ED_1MPROVEMEN ` s '
T LOCATION
Y
Address: 2 r41
Legal Description: 9�� aa 2K 4 Uk.
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
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,CONSTRUCTIQI UNFORIVIATION Add
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i ona workto e e orme under this permit—check all appy:"
HVAC Gas Tank E]Gas PipingOGenerator
Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ t9 3bo&00 Utilities:,n Sewer Septic Building Height:
OWNER L SSEE- '
Name t Name:
Addres . / Company:
City: a e: Address:
Zi Code: ._,L
p < Fax: City: State:
_3L
No. Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State o ounty License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 permit will authorize the ppermit 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,lin 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 recordi our Notice of Commencement.
s
_Signature of Owner/Lessee/Agent ature of C ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ZA v, +„sem COUNTY OF o
The fo oing instr ent was acknowledged before me The f rgoing instrurr�e{�t was acknowledged before me
this day of 20 Lby this LJ� day of (� 20 l� by
D��
(Name of per ck wledging) (Name of p n knowledging)
OignaAre*ofthta�ryPlubilic-S2Eetf Florida) t re of Notary Public-SAAe of Florida)
Personally Known Produced Identification Personally Known OR Produced Identification
Type of Identification Pr u tltr�„ ., :... Type of Identification Produced
1'ASIIAHN ,.• LA
�"+i= 1-�tO• o ( 1 A(NGRAM 'r° Notar
Commission No. M biic Commission No. Y P�{$eal)tate of Florida
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ail) State of Florida t :,A° ; =My Comm.
It Of��oo' Commiss11 ion)# Decres 20'2018,1771.� gr F4o;� Commission# Decres 20'2016
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rough National Notary Assn.
Revised 07/15/2014 Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
_T INITIALS