HomeMy WebLinkAboutBuilding Permit Application- %JJc Pik- Sk",W,lro(f for
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ((��
Date: _ Permit Number:_
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 _ i� Residential
PERMITTYPE:
PR-OPOSED IMPROVEMENT LOCATION':
Address:
Property Tax ID#: 3o o0oL C)oo Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK.
:.. ..,
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 _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $) 040 Utilities: —Sewer, _Septic Building Height:
OWNER/LESSEE.' "
CONl RACTOR:
r. .
Name JA L L16 rV
Name: 66t- ✓~
Address:
Company: W
Address•. 0,
I13W
Citys' State: .
Zip Code: 3,�3.$y.` Fax:"
City: State: F(--
Phone No. `'
Zip Code`. ! .3 i5 U' :.Fax: l!� !o 0, 5
E-Mail:
,.
Phone.No 105(k7.. _
E-Mail
Fill in fee simple Title Holder on next page (if different
State or County License
from the Owner listed above)
IIt value of construction is SZ500 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.
-SUPPLEM,ENTAL.CONSTRUCTION LIEN LAW INFORIVIATIQN „
.. L . .
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF
COUNTY OFORIDA
The forgoing instrument was acknowledged before me
this dayofT/`e— 20a by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Flori/Ida�) I
Commission No. I r.Chris
tary Pub11a a of Florida
?,VL Woolley
M Commission GG 185666
STATE OF FLORIDA
COUNTY OF T
The forgoing instr ment was acknowledged before me
this day oft..4--' 20/ by
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signature of Notalry Pu Rb�
Aw Notary Public State of Florida
Commission No. if f Chris ! !RmissOfley
My Co n GG 185665
avN Expires 02/26/2022
V#J,,.dF
Expires 02/26/20
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