HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: - �G� (('( 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 LZ
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION`f: = .
Address: Gjcl (� Q�dc r i a r
Property Tax ID #: �� i (7 D!j^ �� A (� W Lot No. �L
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit = check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ (» :� Utilities: _ Sewer _ Septic
n�4-erl �
Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE
CONTRACTOR;
Name 4P_CCc1
Name:
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Company: Aw'). 1: ' .
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Address: -
City: 2State:
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Zip Code: M5 19 -a- Fax:
Phone No. Cam=
Address: LICi!-3
City: ErC rctQ_
Zip Code:
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State:�al
Fax: 14
E-Mail: Q (_�_(z "ra 5 1U2 T
Phone No _
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Fill in fee simple Title Holder on next page ( if different_
from the Owner listed above)
State or County License
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It value ot. construction is 57500 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 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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:'
Signat caner/ Lessee
ractor as Agent for O
on r icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF S+ LMc,' <_
The forgoing instrume t was acknowledged before me
-day
The forgoi g instrument was acknowledged before me
this of
_, 20 11 by
this �,day of 2011 by
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced
Identification
Personally Known OR Produced Identification
Typ of Identification
Type of dentification
Pr ced
Produ e
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