HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE -ACCEPTED
Date: i Permit Number: 10(0
_ 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 d/
PERMIT TYPE: �t
Additional work to be performed under this permit —check all that apply:
mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: .
Cost of Construction: $ 000 Utilities: —Sewer _Septic Building Height:
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Name %
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Name: �" l S a e Ct
Acl&ess:
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Company: S194
City \ V Stater
,•Zip Code:3 �, S Fax:
Phone No. �'`l 2: �-i V -- C% 23 yZ
Address S,
CiiT.. ate:
Zip Code: Fax::.
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Phone No . -772
E-Mail: ;
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
' E-Mail a 146 0-
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.
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DESIGN ER/ENGI NEER: Not Applicable
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MORTGAGE COMPANY: ApplicableNot
Name:
Address:Name:
Address:
State:
Zi p: Phone
City: State:
Phone:City:
Zip:
FEE SIMPLE TITLE HOLDER: Not Applicable
COMPANY:Applicable
Name:
Address:Name:
City:
Phone:City:
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 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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/
STATE OF FLORIDA
COUNTY OF
ntractoras
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing ins ment was acknowledg before me The forgoing instr ent was acknowledged before me
s thi_ day of 20� by this '-Iday of l 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identifications Personally Known OR Produced Identification'
Type of Identification Type of Identification
Produced Produced �1-
W�YU�4
(Signature of Notary Public-
MING
(Signature of Notary gf}gHNAINGRAM-RAHMIN(
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LASHpf{,yA1NGRAM-�
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=: ;#_ MY COMMISSION # GG 275061
Commission No.
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COMM�3,Q�#fGG275060
0 2022
Commission No. "' o`= E�(��:December'20,2022
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�(pIRES:December`2 tars
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REVIEWS
F T
ZONING SUPERVISOR
PLANS VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW REVIEW
REVIEW REVIEW
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.