HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: (qvl
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: U 11-6rt//� rrt
ry
Property Tax ID #: c1 ' ® - 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
X Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ?� Utilities: —Sewer —Septic
Windows/Doors
_ Roof Pitch
Building Height:
QlNNER/LES� E
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Name Si� `t—j4�, ,P
Name: % G(
Address: �-)-G
Company: �� �, ��� i 4 /--6
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City: State: C
Zip,Code: 3�%li'i `�_ Fax:
Phone No.
Address: 'J'Q
City: o Stater
Zip Code:_ Fax:
Phone No _'5 Talc
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail GD
State or County License �z 0 �( 9
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:
State:
Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Contractor/License/Holder
Signature o Owner/ Lessee/Contractor as gent for Owner
STATE OF FLORIDA -
STATE OF FLORIDA
COUNTY OF _
COUNTY OF
The rgoing instru ent w s acknowledg efore me
The or ing instr en wa acknowledge efore me
thi day of 20_t by
ttdj� ay of 20 by
Name of person making statement. U
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
T e of Identification
Type of Identification
ro uced
Pr ced
( igna re o otary Public- St Florida)
na ure of Notary Public- St f Florida )
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