HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Tj� � �=
Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
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: '} 1 I. J t' -5, . � \ W �/
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ti c e
Legal Description: —0k ( in k , C
Property Tax ID 4: L6t L2, T `' S
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Lot No.
Site Plan Name:
Block No.�
Project Name: _
Setbacks Front __ Back: - Right Side:
Left Side:
DETALL&3,DESCR[PTION OF WORK:
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CONSTRUCTION INFORMATION:
A dd s i is work to 6ertormed un er triis permit - cleck
HVAC
all apply:
-
'^ Gas Tank Gas PipingShutters
Windows/Doors
Electric L_J plumbing Sprinklers
U_ Generator
Roof Roof pitch
Total Sq. Ft of Construction: 12 is � ; tr !
5Ft of First Floor:
Cost of Construction: 5 �L F� C��, Utilities:nSewer L =.ISeptic
Building Height:
I OWNER/LESSEE:
CONTRACTOR:
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Name: ;_ r 1e r'
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Address: `'
Company:
City: ' State:
Address:�-
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Zip Code: a �2 Fax:_ ' ;- m--
I City:
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Phone No. 17 2 -- .r - r5`� _
Zip Code: 7 16
Fax: 7 7 7
E -Mail: tt� ---
Phone No.
Fill in feesimple Title Holder on next page ( if different
E -Mail: li-i , ' _, ,
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from the Owner listed above)
State or County License:
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if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
DESIGNE
Name: _
Address:
City:
Zip:
ENGINEER: _ Not Applicable
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address;
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
e:
Not Applicable
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 }obsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commenci ork-or,recordi f Commencement.
ARbudb—
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Signature of Owner a Contractor as Agent
STATE OF FLORI
DA.r�`
COUNTY OF
The fI rrstr rgoing-i06t was arlc W ed before me
this _/`_dav o I,', , : , /-, 20. +'
person/ackn Iedging J
C
(Signature of Notary Public- State of Florida i
Personally Known i,1 OR Produced Identification
Type of Identification Produced -_
Commission No. (Seal)
Revised 07/15/2014
Signature of Contractor
STATE OF FLORIDA
COUNTY OF
_iThe forgoing ins rurn-errt w cknowledged before me
# day of c • 20 by
(Name of person acknowledging j�
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
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COMPLETE
INITIALS