HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED A0.
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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
PERMIT TYPE:
R •POSE IM,/P;OUE EN LOCATION:
Address:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
DET IL D CSC« PTIO O'F WORK:
� c
AL
I«ONSTRU ION INFORMA ION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping —Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers 'Gen erator _ Roof: ("z Pitch -
Total Sq. Ft of Construction: 7 6 Sq. Ft. of First Floor:
Cost of Construction: $ _ aUtilities: _ Sewer _ Septic Building Height:
O EAR l =�S�SE '
�t•�NTRA T(! ,
Name e �r� CCe
Name:
Address:
Company:
City: `�G Stater
Address:
,City:. , State:
Zip Code: Fax:
Phone No.� T%� ,_ %%1
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
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 CONST' UCTION LIEN LA INF � RMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable,
Name:
Address:-
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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."
Ae�
Signature of Owner/ Lessee/Codtractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF &Mk AW,,e2�
COUNTY OF
The forgoing instrumen was acknowledge before me
The forgoing instrument was acknowledged before me
this day of 20c1 by
this day of 20_ by
Name of person making statem t.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of IdentifiFatio
Produced
Type of Identification
Produced
(SigWatdre of Notary Public, 01 Faftithlt)GRAM-RAH MING
(Signature of Notary Public- State of Florida )
tlly COMMISSION # GG 275060
c; :;:�;Q�_ EXF'
Commission No. �,: (SMIPecember'20,2022
Commission No. (Seal)
; - Hoed ru N-_ etalY Public Underwriters
-REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19