HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION
TO BE ACCEPTED
Date: lL I' I� Permit Number:
•
• Building Permit Application
Planning and Development Services
Building and Code Division /
uRegulation,Fort
2300 Virginia Avenue, Fort Pierce FL 34982
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential .1///
PERMIT TYPE: — — --- —
�
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID k:
Lot No.
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
r
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ I ffo, Utilities:
_Sewer _Septic Building Height:
OWNER/LESSEE—CONTRACTOR:
—
Name n Name: Sh {
Addr ) 1)Q ( Company Idi
City:1 ) State: El— Ad s: C
I
Zip Code: �1 Fax: City: v
Phone No. State:_
I Zip Code: Fax:
E-Mail:
Phone No X3!3
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License ��f �fo7 i L�� a—
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 LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not pplicable
Name:
Name:
Address: Address:
City: te: _ City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
BONDING COMPA Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a to do
permit the work and installation as indicated.
I certify that no work or Installation has commenced prior to the issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cohWict 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."
5ignat�o of Owner/ Lessee/LUntractor as Agent for Owner Signatur Contractor/License
STATE OF FLORID STATE OF FLORIDA J / I
COUNTY OF , I I J / I
COUNTY OF
The forgoing instruthent was acknowledge before me The fro". instrume as acknowledge efore me
thiyof_Un� 20 �uby this'
yof 20 Y
s n h r�
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known /OR
Type of Identification -- Produced Identification
Type of Identification
Produced
Produced
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( ignature of a Public- tate 0 1 d '
,Qy.z;•. (Signature of Nota Pu lic- i )p �y
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Commission No. : TSeal)�� •• it �� to
— _*t ;*- Commission No.�_;_
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DATEREVIEW REVIEW q�u�!q JEW
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RECEIVED ZI/IIIIf11111MN\�
DATE
COMPLETED
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