HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICA$L INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Planning and DevelapmentServices Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-155 Fax: (772) 462-1578 Commercial
---� Residential
PERMIT APPLICATION FOR; --------_
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PROPOSED INPROVEMENT LQCATiON
Address: C
V '\J� Y- `
Legal Description:(. nY,,--' �'rr^jV'% ^-1 i a ;
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
-�� Back: -•--______ Right Side:
DETAILED DESCRIPTION OF WORK:��—Left Side:
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CONSTRUCTION INFORMATION:
rtiona Fwor to e e Orme
un ert is perm it -e ec a appy.
HVAC Gas Tank
Gas Piping _Shutters
ectric � Plumbing
Totals . Ft Sprinklers Generator
Sq- of Construction:
Scl Ft. of First Floor:
$ Q�
Cost of Construction: Utilities: Sewer
OWNER%LESSEE: septic
Name CONTRACTOR:
Address:
I �F�
Com any:
City:
Zip Code. c State; Addr s:'
Phone No. ,,. ° i a 3'2' City: y
E -Mail: - Zip Codeaq 0
Fill in fee simple Title Holderphone No
on next page { if different
from the Owner listed above) F -Mail: !'(t`; {� Cid i
State or County Licenser
If value of construction is $25C4 or more, a RECORDED Notice 4f Commencement is required.
Lot No.
Block No.
Windows/Doors
t �J Roof
Building Height:_.
Stater_
Fax:
SUPPLEMENTAL CONSTRUCTION LIEN LAW
INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Address:
Name:
City;
Address:
State:
Zip: Phone:
City;
State:
Zip: � Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: —
BONDING COMPANY:
Address:
Not Applicable
Name: ^"
City:
Address:
Zip: Phone:
City:
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 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 a first ins ection. if you intend to obtain financing, consu
COMMenci r or reeor I ur Notice of COMmencemP n attorney before
_ Signature of Owner/ Lessee/Agent w r„
STATE OF FLORIDA''' t5
COUNTY OF " `'
Z 6
The f r Ding instrument was acknowledged before rrg o o
this(Nay of .i 3 20 .�by z •� 2 �
[Namejrf person acknowledi:inQ 1
(Signature of Notary Public- State of Florida )
Personally Known �- OR Produced Identification
Type of identification%P�roduced
Commission No.E/—/ (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
of
Holder�
STATE OF FLOR , At--,
COUNTY OF cp o
The fgrgoing instrument wa acknowledged before m
thi day of li ' Vi,'�(� ff
20 by o
0
r w
(Name ofd 'rson acknowledging)
r *
( ignature of tory Public- State of Florida } rfr�i• ��.*'
rrrau�`�
Personally Known L/AOR Produced identification
Type of Identification Produced
Commission No. E _ qVV d_1 (Seal)
SUPERVISOR I PLANS
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CONSTRUCTION TYPE:
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D residential
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New Installation
Q Old Installation
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