HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Permit Number: � -- or) • o(400
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
PERMITTYPE:
Address: 56« l'-1&,Yo c/ () C
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit —check all that apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric V_/Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 00
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Building Height:
OWNER/A111g EE: NCONTRACTOR.
Name 1(-)e-/-i-
Name:
Address: '' 3
Company:
City: QC4 Lvce State:
Zip Code:, ' Yqg/ 2— Fax:
Phone No'. %7z
Address:
City: State:
Zip Code:- Fax: .
Phone No
E-Mail: I Jfl L 'Cr 777e 9r7 & c • OQM
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 $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.
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDINGCOMPANY: 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 LEN OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
igna ure o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTY OFF ,
COUNTY OF
The f going instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day ocl, P9. 200 by
this day of 20_ by
1
Name o person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produ d
Produced
g ture of Notary Pu 'c- Sta e of Flor' )
(Signature of Notary Public- State of Florida )
Commission No. _- _cPan
Commission No. (Seal)
LASHAHNA INGRAM-RAHMING
EXPIRES: Dam r ,)
REVIEWS FR0;6Uf';;p, Z�IpNNotz 1�QR
PLANS VEGETATION SEA TURTLE MANGROVE
COU ers
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ 7/ 19