HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLI ABLE INFO UST BE COMPLETED FOR
Date: L I1,:�)I 1
ON TO BE ACCEPTED
Permit Number:
loommonsmoommoommom Building Permit Application
Planning and Development Services
Building and Code Regu otion Division J
2300 Virginia Avenue, F rt Pierce FL 34982
Phone: (772) 462-155 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICAT ON FOR: To Select from drgpbox, click arrow at the end of line
Address:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
Back:
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� unif
Right Si
,Lot No.
Block No.
Left Side:
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Haalil0paiworKTODeperrormea
unser tnis permit— check all apply:
FGas
_ HVAC
Gas Tank
Piping
_ Shutters
Q Windows/Doors
Electric PlumbingSprinklers
a Generator
a Roof
Total Sq. Ft of Construct on://
S . Ft. of First Floor:
Cost of Construction: $
C Utilit�es:Sewer
Septic
Building Height:
... .
CONTRACTOR:
Nam
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Name:
Addr :3-7 q 17 iCompany:
Cit State 1 Addr ss: N -L
Zip Code: Fax: Ci State:
Phone No. Zip Code: Fax:
E -Mail: Phone No.
Fill in fee simple Title H Ider on next page ( if different E -Mail:
from the Owner listed bove) State or ounty License: �_ A (" (D1 L4 4
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
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DESIGNER/ENGINEER: _Not Applicable
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MORTGAGE COMPANY: Not Applicable
Name: i
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Ph ne:
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 ori stallation 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 anV 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 gra iting 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
'ecorcl
commencing work or ur Notice of Commencement.
Signature of Owner/ Agen/Lessee Signature of Contra ctor/Licenseolder
STATE OF FLORIDA STATE OF FLORIDA
'
COUNTY OF COUNTY OF
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ing instr ent w c ledged before me
The %mooing instr ent wilsAckn wledged before me Th1!!7day
this l 1 day of 20 by thi20bY
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(Name of pets ac nowt ging) (Name of persona knowled ing )
(Signature of Notary7"OR
State of rida(Signature of Notary P lic-State of Frida )Personally
Known Produced Identification Personally Known OR Produced Identification
Type of IdentificationProduced Type of Identif'c tion Produced
Commission No.l—
(Seal) j Commission N
CRYSTAL MARIE CRUZADO
MY COMMISSION
Revised 07/151' EXPIRES June 25, 2020 = CRYSTAL MAR) E CRU2AD0
407 398 i 153 RondallotaryseryCC= �. MY COMM►
Z SSION # FF
(407) 398-0153 S June 2 2020
REVIEWS FRONT ZONING SUPERVISOR II!, PLANS VEGET ;o,IANG OVE
COUNTERREVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS