HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLIC BLE IN MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•J
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 LOCATION:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
Lot No.
Block No.
I DETAILED DESCRIPTION OF WORK:
C � e cv�- (:)\d -TcDn QUcctge nor a
7CiCV_.L��
. .........
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit— c ec all apply:
NHVAC Gas Tank Gas Piping In Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof E: Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S- Ft. of First Floor:
Utilities: 'n Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name[ o -)CJ
Name
I K(k"j
Address: _�LA Z.. N),-I,-cqit'chn i_ \O Q 6h
Company: V,gbl-er M?_tn'ic c�,
State:
Zip 3-Y 9
'nee
Ad d rl;;;
�—OLi
Code: Fax:
City: - c)-(-+ t State:
Phone No.
Zip Code: ,, jP"
j�0 Fax:
E -Mail:
,5QC
Phone N o. 0 zP-71 -
Fill in fee simple Title Holder on next page if different
E -Mail: CM
from the Owner listed above)
State or County License:
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: � Not Applicable
Name: _
Address:
State: City:
Zip:
Not Applicable
State:
Phone:
BONDING COMPANY, Not Applicable
Name: _
Add rens:
city.
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
St. Lucie County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, u es, 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, perforin 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 attorneybefore
commencingwork or recordin a nt.,
our Notice of Commencem
�
Signature of owner/Lessee/Contractor as Agent for Owner
1
STATE of FLORI '
COUNTY OF
The f oing instrument was acknowledged before me
this day of 20 lay
(Name of pL6son acknowledging)
(Signature of "ry Public -State of Florida )
Personally Known : ,ducedyfi�i�
Type of Identification Pr c UV
r
EXPIR'gS vember 03, 2020
Commissio �Uo. ' "' ' (sear
�� YI -7c)
Revised 07/15/2014
Signature o
Intracto(/License Holder
STATE OF FL0131 A `
COUNTY OF ��" ll.)(' .i P-1
The fo�oing instrument was acknowleded before me
this day of hL�j� iYi �,� , 20r' by
(Name of person acknowledging)
(Signature of N^+ -Ary Public- S ate of Florida7
j
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Seal
s`'•�`�" MARY KUCHTA
EXPIRES November 03, 2020
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