HomeMy WebLinkAboutBuilding Permit ApplictionOWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or Installation has commenced prior to the issuance of a permit.
St. Lucie Coun7[y 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 antl 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 Cou ny Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen roams and accessory uses to another non-residential use
WARNING TO OWNER: Your falfure 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
comme(n/nc-i�ing work or recording
ou-r- Notice of Commencement.
Sgnatucnr owner/Lesse/ontraaor as Agent for Owner SgnaN�nt�U�nu Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF_ ,5�. �JIAItPi COUNTY OF I,
The f�j�qI�ng instryme as acknowledg efore me The for Ing instr e t was acknowledg fore me
this.Llfrgay of F•(Cl . 2p by this day o(�Zp
- yy
Name of person making sta ent. Name of person making sta ent.
Personally Known OR Produced Identification _ Personally Known OR Produced Identification
Type c Identification Type of Identification
Produced Produced
AgizNlll NNNN
(Signature of Nota Puh lc Sta o.Ai� (Signature of Notary bh-State of da iW
Commission No. ISWI- •.* 3
Commission No. 11 Jeal) Za"'
rca tNns aG6 f/7rla
REVIEWS FRONT ...... ••' f•
COUNTER RE SOR PIANS VEGETATION SEAREVIEW dY
' 1 EW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:_ CRY: State:
Zip: P n Zip: ho
FEE SIMPLE TITL HO _Not Applicable BONDING COMP _Not Applicable
Name: Name:
Address: Address:
City:
Zip: Phone: City:
ZIP:
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or Installation has commenced prior to the issuance of a permit.
St. Lucie Coun7[y 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 antl 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 Cou ny Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen roams and accessory uses to another non-residential use
WARNING TO OWNER: Your falfure 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
comme(n/nc-i�ing work or recording
ou-r- Notice of Commencement.
Sgnatucnr owner/Lesse/ontraaor as Agent for Owner SgnaN�nt�U�nu Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF_ ,5�. �JIAItPi COUNTY OF I,
The f�j�qI�ng instryme as acknowledg efore me The for Ing instr e t was acknowledg fore me
this.Llfrgay of F•(Cl . 2p by this day o(�Zp
- yy
Name of person making sta ent. Name of person making sta ent.
Personally Known OR Produced Identification _ Personally Known OR Produced Identification
Type c Identification Type of Identification
Produced Produced
AgizNlll NNNN
(Signature of Nota Puh lc Sta o.Ai� (Signature of Notary bh-State of da iW
Commission No. ISWI- •.* 3
Commission No. 11 Jeal) Za"'
rca tNns aG6 f/7rla
REVIEWS FRONT ...... ••' f•
COUNTER RE SOR PIANS VEGETATION SEAREVIEW dY
' 1 EW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:_ CRY: State:
Zip: P n Zip: ho
FEE SIMPLE TITL HO _Not Applicable BONDING COMP _Not Applicable
Name: Name:
Address: Address:
City:
Zip: Phone: City:
ZIP:
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / /—/ '7 Permit Number:
L 'J :1
-
•
Building Permit Application
Planning and Development Services -
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 1
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓Y�
Property Tax ID #:3,334— 5D(D- np 5c0'"ot )o—ic2 Lot No.
r
Site Plan Name:
Project Name:
Block No.
DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit—check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters
_ Electric 'Z
Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 130 D. D l Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER ESSEE:
CONTRA OR:
Name
Name:
Addr
Compan
Ad
City State• _
Zip Code: Fax:
Phone No.
City:
Zip Co
Phone
State:_
de: Fax:
No ^
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
r
E -Mail �
State or County License"0 Fe -I yap
it value of construction is $2500 or more, a RECORDED Notice of commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.