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 Residential
PERMIT TYPE M�� Or-
PKdPt3S�D IMF RNEM 4T,LOCATION; 3
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
1 J4;1
Lot No.
Block No.
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:
Cost of Construction: $ 500,06
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
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City: _rY �i'G' »G 9 State:
Zip Code: Fax::
Phone No.7,12.(t(o�r_ 6257&a_ 21(a _!r�i �_
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip -Code: :,;Fax:
Phone No
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.
DES IGNERANGINEER:
Name:
Address:_
City:
Zip:
Phone
Not Applicable
State:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
4gqnature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OY FLORIDA
COUNTY OF
The forgoing ins ument was acknowledge before me
The forgoing instrument was acknowledged before me
this � day ofu by
this _ day of 20_ by
Name of person making statement.
Name of person making statement.
\
Personally Known OR Produced Identification 14
Personally Known OR Produced Identification
Type of Identificat on
L. ^'
Type of Identification
Produced
Produced �
(Signature of Notary Public- 5�ate of Florida) ,.
�(Inature of Notary Public- State of Floriday�GG
2T5
No. vPLjy1�f11SS10N 20
fmission No. (Seal)
pCommission
`!C be`ecm
WIGUnde
gonde
REVIEWS
FRONT
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19