HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:`` )-0 &� I 23 Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: *\ , 3�945
Property Tax ID #: 00000Qf� oZ..
Site Plan Name:
Project Name:
Lot No.
Block No.
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ /<0"7 0-0
Utilities
_OWNER/LESSEE:
Name
Address:
City: State
Zip Code:,— Fax:5�A- UA'%-1P403
Phone No.
E-Mail: r,--
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
co
Sewer _ Septic Building Height:
RACTOR:
Name:
Company:
City: _1kJ_•j21 State:
Zip Code: t1 l ( Fax 5 w\- k0'2%- 50`04
Phone No '�'.� _ 7/(Z--" — E?028'!::�
E-Mail � -cc Lnr;�'-'.- .('non
State or County License [-GC' C _5? 67n
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 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."
Signature of Owner/ Lessee/Contractor as t for Owner
Signature of Contractor/license Holder
STATE OF FLORIDA ��'nn � J�k�V
STATE OF FLORIDt'.1 1 iC6
OF
COUNTY OF "` 1
COUNTY
The fgrgoing instruVrasckwledgq¢,before me
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The fvrEping instru I�ig}fledg�y�before me
this day of �JC 20 �'j b
this day of
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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
P duced
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REVIEWS
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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DATE
COMPLETED
Rev. 2/7/ 19