HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �Q
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
MOROSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: (YJ3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED'DESCRIPTtON-"OF`1NORK E w'
.; r
iry I& C�n
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check all appy:
HVAC Gas Tank Gas Pi _ Doors
❑ Piping g Shutters
Windows/❑
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
(P
Cost of Construction: $ Utilities: _Sewer E]Septic Building Height:
OW ER/LESSEE. _ ��CONTRACTOR::
Name S Name:
Address: '3IZ (QUO—J4 -` n Company:
City: State:v"vl Address: C:L1Vd
Zip Code:L� n Fax: City: eP/(Q State:
Phone No. Zip Code:( Z Fax.—E _L6LP(- 14( j
E-Mail: Phone No. —
Fill in fee simple Title Holder on next page( if different E-Mail: S Cd
from the Owner listed above) State or County License: t� C:l�c9�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY;'! _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:'
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FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I
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I certify that no work or installation has commenced prior to the issuance of a permit.
I
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,inliall 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 resultsI 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.
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Sign atu wn e r/Lessee'yCo-n`Wa—Ctb r as Agent for Owner SignaM"LORIDA
ontractor/License Holder
STATE OF FLORIDA STAT
COUNTY OF COUNTY OF
The for ing instru nt was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 Eby this �l day of_�( 20 L(p_by
J�Q Pl
(Na a of person acknowledging) (Name of person acknowledging)
(Signat re of Notary Public tate of Florida) (Signature of Notary Public-St of Florida)
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Personally Known OR Produced Identification Personally Know. _ Cl P o u d d ti is 'o
Type of Identification Produced Type of Ident.1ication-iproduced
U�Ppv PUBC�'i
Notary Public-State of Florida.
Commission No , Commission « - •? M Comm.Expires q� )2018
,�o. s�•,, ASHAHNA INGRAM =�;� o�;� Commission #FF 177249
Y.
Notary public-State of Flo 8ondedlthrough National Notary Assn:
xpires Dec 20,2018
9 F Commission #FF 177249
Revised 07/45/N,I Bonded through National Notary y Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS