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
;PERMITTYPE:
Address: �' �"c 3 /P
Property Tax ID #: 3 �%
Site Plan Name:
Project Name:
;/
Lot No._
Block No.
z- &a 6, tic�' ' 4-- Ti/�-K 'Pht-P E12 /Lc-p 1kt-e hk y R,a-d
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: C Sq. Ft. of -First Floor:
Cost of Construction: $ _SOU , �6 Utilities: —Sewer _Septic Building Height:
e E / SE
CONTRA
Name Frei )lf D✓;L' C
Name:
Address:- .�' 3 P1a ( nv�
Company??
City: pa n l0 i a State: 1= L.
Zip Code: 01 $ Fax:
Phone No. -10 �Z
Address` --'-
City:,. -" State:
;)Zip Code:_ _.. Fax:
Phone No
E-Mail
E-Mail:t
Fill in fee simple Title Holder on next page ( if different
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.
SU PLEMEN AL CON. TRUCTION LIEN LAW INFO
�MATIC7�N:
DESIGNER/ENGINEER: ' Not Applicable
Name:
MORTGAGE COMPANY:' Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: Stater`
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not,Applicable
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 th'e approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full cohcurrency 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."
Signature Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE F FLORIDA \\ I
STATE OF FLORIDA
COUNTY OF 1k�Ar a
COUNTY OF
The rgoing instr ent was acknowledg d before me
The forgoing instrument was acknowledged before me
this day of 20_" by
:
this day of , 20_ by
Name of rn making statement.
Name of person making statement.
`�'•
Personally Known OR Produced Identificationy
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
gnatLCre
Produced
of Notary Pu ic;.�,
��';;; LASHAFINAINGRAM-RAHMIJa
(Signature of Notary Public- State of Florida )
rr:•.r :� MYC NG
Commission No. Cj=�.;: � .e_ i�I�SION#GG275060
Commission No. (Seal)
j`FOc; EXPI ES: December'20, 2022
P�onded Thru No Pub'
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19