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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: --.b Permit Number: 9 4 iGEii1f:C1 L IN * •r 2��� - Building Permit Application JUL Planning and Development Services permitting p,partment Building and Code Regulation Division S* LAc!e County 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ° PERMIT TYPE: P.,1119,OR E;I DI IRMA 0 MIN, LOC TION: �j Address: "S 5 Property Tax ID#: �� V V� ` Lot No. Site Plan Name: Block No. Project Name: DETAILED DESCR+1'PTI3 DN WXF NNRK: CONSTRU.C*TION INFORMATION: r Additional work to be performed under this permitf—6eck all that apply: / _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _/Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction:6/ 4�� <g�/� Sq. Ft. of First Floor: Cost of Construction:$ ) t� Utilities: _Sewer _Septic Building Height: OWN@R,T%@ SSEE: CONTRACTOR: Name e E Name: - Address:_Z5 l 5�.4 &4. Dk Company: City: ��� Cf'�`�' State _� Address: Zip Code Fax: City: State: �G . Phone No �' � Zip Code: Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page different , E-Mail from the Owner listed above) `= � P,� 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. �� c)l►�. Aro twpmmmNwqmSTRUOI©N ttEN LA►W INF©RMATt©N; 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 BEF RE RECORDING YOUR NOTICE OF COMMENCEMENT." ' � 2 Si re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF , I Com__ COUNTY OF The foyroi�ng instrument w s acknowledged before me The forgoing instrument was acknowledged before me this ay of c7 20)4by this day of 20_ by Name of person making statement. 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 Putate of Florida) (Signature of Notary Public-State of Florida) Commission No. "'Vd'' � ELLEI�$�UGHN Commission No. (Seal) �: tate of Florida-Notary Public .= Commisslon #GG 270079- .,FOF«o issi n Expires REVIEWS R PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIE REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.