HomeMy WebLinkAboutBuilding Permit Application I1
ALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CO- Permit Number: I
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
PROPOSED IMPROVEMENT LOCATI N:
Address: u-
Legal Description:
Property Tax ID#: ro U ��' Lot No.
Site Plan Name: 44 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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[CONSTRUCTION INFORMATION:
Aciclitional work to be nertormed under ft-is permit-check all appy:
OHVAC Gas Tank ❑Gas Piping OGenerator
Shutters Windows/Doors
0 Electric Plumbing Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 1 Utilities:]Sewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Nam Name:
Address: Company:
City: tv Ck-, StateeL Addr s: L
Zip Code Fa : City: r State:_
Phone No. zz Zip Code: 1 Fax: ��S-`
E-Mail: Phone No. L� �Q
Fill in fee simple Title Holder on next page(if different E-Mail: t
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
AA..
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 thepermit 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 the first ' ction. If you intend to obtain financing, consult with lender or an attorney before
commencin ork r recording our Notice-of-Commencement.
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Signature r Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI g6k
TATE OF FLORID*COUNTY OF � COUNTY OF Ka/m
The fq{going instrum ftt]�as acknowledge before me The forgoing instrument was ac nowledgeP before me
this Ida of V 0 ? by this�day of A) 20 ( by
(W L r U,
(Name of person acknowledging) (Name of persona edging)
(Signature o otary Public-State of Florida) (Signature otary Public-State of Florida)
Personally Known OR Produced Idents fc _. Personally Known 0 tification
Type of Identification Pr v .,�,r Type o rr
l ..445�Y IASIP 4
IdY CO\4i
ION�#FF 000371 ;_�' `�: MY COPo1h?iSSION#FF 000371
Commission No. _". �` 2017 _ 22 2017
E508' : 242-
July 2 , Commi o FxPIFiES:July ( al)
Bonded-1hruP:otaryPublioUndervj6ters t Note est-Undzrn�ters
L_-
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS