HomeMy WebLinkAboutBuilding Permit ApplicationII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:. +� Oil • ���p3
s 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 Vf
PERMIT TYPE:
Address: CD Z_U� r)lTL' E)� 1)6 �2
Property Tax ID #: t�q CQ_ • `�'O�' h3? • ��LJ—� Lot No.
Site Plan Name: Block No.
Project Name:
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: $ 30p. Do Utilities: —Sewer —Septic
Windows/Doors
Roof-. ' Pitch
Building Height:
OWNER/LE=�SSCE:
CONTRaCTt3R:
Name
Name:
Address: i ,
Company: - -
city: �orfi lCdb State:EL
Zip Code:Fax:
Phone NogOy-Q2 _-J0'2
. Address: -
t City; - State:
Zip; .Code: rFaz
'Phone No' -
E-Mail: 4 lowin 0
Fill in fee'simple Title Holder on next pa ( 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.
' II -
SUPP EMENTAL CONSTRUCTION LIEN LAW11 {NFORMATION:
iDESIGN ER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: t., 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
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 agr'ee.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 Y LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
6(z4 7D
Signature of Owner/ Lessee/ on ractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF T�A)&A
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of �Q 20_ by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden is tion
Type of Identification
Produced �_
Produced
igna ure of Notary Public- S to c Florida)
(Signature of Notary Public- State of Florida )
Commission No. ss'Y"�;, LAS� INGRAM-RAHMING
Commission No. (Seal)
MY COMMISSION#GG275NO
EXPIRES: December20, 2022
off:
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;:,•'Honded Thru
Public Underwnten
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SUPERVISOR
REVIEWS
FRON
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19