HomeMy WebLinkAboutBuilding Permit ApplicationAll 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
PERMIT TYPE:
Address: 1 V h a
Property Tax ID #: 1a•
Site Plan Name:
Project Name:
PTiO N D,F'. .
�7��iirf�tra�
"OWNER/LESSEE: -
CONTRACTOR:
Name
Name:
Address:3�C� r\
Company:
City: t . ►exce., —� State:TL
Zip Code: C Fax:
Phone No. 772--90-9
Address:..
City: State:
Zip Code: Fax:
Phone,.No
E-Mail:
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 S2500 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: 6
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. 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 A J ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signatur of Ow / Less ee/Contr ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �_%a
COUNTY OF
The f rgoing instru nt was acknowledge before me
�
The forgoing instrument was acknowledged before me
this day of 20� by
this day of 20_ by
Na U
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Ide ifi tion+n
L
Type of Identification
Produced
Produced
'-,.WignIature of Notary Public- St to of Florida)
(Signature of Notary Public- State of Florida )
Commission No.
Commission No. (Seal)
I ASHAH n975O6O NAWG11M.R
ber*2
,?.022
REVIEWS
ems• l EXP
R W�bllcl
6 ISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
"d
T
W
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ 7/ 19