HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: L �,1� Permit Number:
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Building Permit Application
Planning and Development Services Pes.fiLtting DE
St- t
Building and Code Regulation Division uc�A Pa Ce�nty eht
2300 Virginia Avenue,Fort Pierce FL 34952
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPGSED INfPROVEMENT LQCATION.
Address: 2- -D-0 Q o1_5s� A-Y-�
Property Tax ID#: ��g��C� -0 nca-o Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical Gas Tank _Gas Piping —Shutters _Windows/Doors`
_ElectricElumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Constructionn: Sq. Ft. of First Floor:
Cost of Construction:$ "I U Utilities: —Sewer _Septic Building Height:
QWNER/LESSEE. CONTRACTOR:
�, .., ..r - ,
Name I I'✓l Name: '.
Address: Tye) i° r__ Company:
City: 14 r-r P corC if State:-9-1 . Address:
Zip Code: Fax: City: State:
Phone No. 1 TZ Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) 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.
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 thepermit 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."
Signa re of Own e L ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF Q �_,_ COUNTY OF
The for ng instrument was acknowledged before me The forgoing instrument was acknowledged before me
thifY of 20 by this day of 20_ by
60'1 o n cT
Name of person making stateme0ft. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ' Produced
(Signature of Notary Public-Stat I State of Flbrlda•NrA;; IP,tY9 of Notary Public-State of Florida)
z 4 Cbrhf i§§Ibfi 0 aL '11.70079
Commission No. ; F TSI) Vit` grr,rl��lran '�]py is on No. (Seal)
i+lily� i�yf9L?Q�P �� ��/,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.