HomeMy WebLinkAboutBuilding Permit ApplicationAil APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C /� ! ' l Permit Number:
•
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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 TYPE:
PROPOSED IMPROVEMENT LOCATION: n �1
Address: & %vit' s c t'� !�-k d- -
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric\/Plumbing —Sprinklers _ Generator hoof i Pitch
Total Sq. Ft of Construction:
Cost of Construction:
Sq. Ft. of First Floor:
I
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name .ice
Name: rk
Address: 42o l 0 VA --e- - . c i��� �.e=_
Company:.SoPa.t k Oua f -i e
City: 4., C+tV State: icL
Zip Code: �[p— Fax: *r�
Phone No. A 3 Qk - � !�
Address: t'- �. (z)x 7
City: P'v.� �`-� v State:
Zip Code: 3q?'7 Fax:
Phone No .:2�7 - a'
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mair .Lr I LI � t b t "ve C �
State or County License i` /
If 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,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AM ATTORNEY BEFORE RECORDING YOUR_AOitCE-0-P�COMMEN_CME
Rev.
e of 0 '- rk ee/Contrac#oras Agent for Owner
a of Contractor/License Holder
STATE OF FLO D�°j
STATE OF FLORIDA
_
COUNTY OF
COUNTY OFa- LI lC4-�
The f r Ding instrument was acknowledgedbefore me
The f going instrument was acknowledge�d ,before me
this day of IrwC' 20 by
this�- day of tUCC- 20 1 by
Name of person making statement.
Name of person making statement.
Personally Known `✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Prod ed—
Produred
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