HomeMy WebLinkAboutBuilding Permit ApplicationDESIGNER/ENGINEER:
Name:
/Not Applicable
MORTGAGE COMPANY: - Not Applicable
Name:
Address:
STATE OF FLORIDA
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
?Not Applicable
BONDING COMPANY: (GQNot Applicable
Name:
Address:
Name of person making statement
Address:
City:
Type of Identification
City:
Zip: Phone:
Produced
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain ai permit to do the work and installation as indicated.
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 acc'iessory 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 mustlbe recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
g g
Si nature of Contractor/License Holder
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STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �,C_
COUNTY OF
The forgoing inst ment was acknowledged before me
this day of H fin\ 20 �$ by
The forgoing'instr ment �vas�acknowledged before me
this May of <1 20 LAS by
A�
Name of person aking statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- St to of, Fdoxj�a)
,� TIFFANY A. LEE
(Signature of Notary Public- tate of Florida )
a� ..•.,
Commission No.�������
EXPIRES: April 26,201
t-- e° �4 p°a TIFFANY A. LEE
Commission No. r �,�1� (dal)
My C01�11 1ISSION
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F��R`° Bonded ThruBudgaiNoiaryServias
N e� EXPIRES: April 26,2
9' OFF Bonded Thru Budge; Noiary S:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA.TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 1C
PERMIT APPLICATION FOR: To Select from dropbox, click alrrow at the end of line
Address:i
Legal Description: Ack�\
Property Tax ID #: t�-
Site Plan Name:
Project Name:
Setbacks Front Back:
Additional work to be pjertormed under this permit -check all that apply :
HVAC I _I Gas Tank OGas Piping _ Shutters
Electric ❑ Plumbing OSprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $
of First Floor:
Scn_
Utilities.Sewer Septic
Name 1 ` 1(Dr Nay XY-\Cid }'ZG \ Name: \,3
Address:\.®,--\ Company:'
City: State:-`'— Address:q
Zip Code:�Fax: City:
Phone No. 1a� 3��i--j���, Zip Code: _
E -Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail_T�
from the Owner listed above) State or Co
Lot No. J
Block No.
Windows/Doors
Roof Roof pitch
iy-\� C�x��f`ac
Fax:
:y License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
State: PL