HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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I Date: 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
PERMITTYPE:
PR%YP. SED tM ROUEMEN LOCATION:
Address: Sg00 AIrA45-14 0 V211`.
PropertyTaxlD#: ��a•1Q0�4�W�`
Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE�SCRFPTION O WORK:
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CO,NSTRUCTIO:N 1N'FORM TtON:
Additional work to be performed under this permit — check all that apply:
Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:_
Windows/Doors
Roof Pitch
Utilities: —Sewer _Septic Building Height:
O® WNIESSE
CONTRA'O.R:
Name T N11A —94EA* W
Name:
Address: S :/, %'`1'e #W bp.
Company:
City:T. �,E�^c! ,C State: ,.*/'
Zip Coder 3if7,62 Fax:
Phone No. %7�^ �'/ 9• c2522 o
Address:
City: State:
. Zip Code: Fax:`
Phone No
E-Mail: 7375—e, yd iU 0,-f
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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 LIE 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.
;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
Itructure. 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
n 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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of ner/ Les se /Contr ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
\
COUNTY OF `► klc - o.
COUNTY OF
The f rgoing instrument was acknowled d before me
this day of 20 by
The forgoing instrument was acknowledged before me
this day of 20_ by
\
c DEC, yin,_
Name of person king statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced V1` &Kt
Produced
;Ignature
of Notary Public- tate of Florida)
(Signature of Notary Public- State of. Florida )
Commission No.yMING
MIN G
^27Nil 508�
ommission No. (Seal) _
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DATE
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DATE
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