HomeMy WebLinkAboutBuilding Permit ApplicationAli APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .5— Z! '/9 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia'Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: f �_z/e
Address
Building Permit Application
Commercial Residential v
of I
Property Tax ID #: 340Z" bO.S- i9yY 1900 Lot No.
Site Plan Name: Block No.
Project Name:
I
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 0 0 r 00 Utilities: _ Sewer _ Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/
CONTRACTOR:
!Name
Name:
'Address: D to 7
Company:
City: ewe State:EL
Zip Code: 3 Z Z Fax:
Phone No.
Address:- -_;,:.-.. ,.
City: r;
_ •} � `'r State:
Zip;Code: "Fax:
Phonle, Noa
E-Mail: v
'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.
DESIGNER/ENGINEER:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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.Iucie 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 l will, in all respects, perform the work
in 'accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
Th!e 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 YnuR-LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
XX
S gna ure of Owner/ L ssee/Contractor as 01<1or Owner
Signature of Contractor/License Holder
(STATE OF FLORIDA
STATE OF FLORIDA
;COUNTY
COUNTY OF
;OF ��i��RG�,Q„
The forgoing instrument was acknowledged before me
iThe forgoing,instrument was acknowledge before me
this day of 20_ by
this day of 20Z by
�C7�V�Q�fi 1��CjVb\Q,�il!
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
(Signature of Notary Public- to of Florida)
Commission No. _LASHAHIg _RAHMING
MY COMMISSION # GG 275060
'•.,,PFFt`;,••,BondedThruNotary
bllcUnde
REVIEWS;
F
:,PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19