HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -
Date: Permit Number:
rRECEIVED. .
. A $ Zoti9
Building Permit Application p,mxtt\n91eC0U"
St. l ua
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax; (772) 462-1578 COmmeroai Resilientiai _
PERMITTYPE:}� _
-.PROPOSED IMPROVEMENT LOCATION,.
CONSTRUCTION -INFORMATION
Additional -work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank; .. _ Gas Piping _ Shutters - Winddws/D000rs
_ Electric - Rlumbing '.! _ Spririklers _ Generator Roof / Pitch
Total Sq. Ft of Construction- Sq. Ft. of First Floor:
Cost of:Coristruction: $ 00 Utilities: Sewer _Septic BuildiPg Height:
g1NNER/LESSEE:
CONTRACTOR:
Name ;; ....
Name
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Address: S -
Company: rr ZAS
City:. �6i� LV C �� ' " State:
Addressl --;t
,
city.".- -
Stater
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Zip Code: Fax:
Phone No. _] . j ` (0 1 — � 7S 15!
Zip Code:
Phone No
Fax:
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail 2,
from the Owner listed above)
State or County License
QQ,
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,PPLEMENTAL,CONSTRUCTI:QN LIEN LAW INFORMATION:;,
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 andlcovenants.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 1" 't
Si atu of Owner/ Lessee/Contractor as Agent for Owner
Signature o Contractor/License Holder
STATE OF FL M
PW&r
STATE OF FLCOUNTYOFan
COUNTY OF
The fo g instr ent was ac owledg efore me
this �y of 20_by
The f oing inst ment was a knowledg efore me
this day of 20f 4by
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Name of person making statement. Q
Personally Known OR Produced Identificati�nx
ame of person making -statement.
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Personally Known OR.Produced Identificald r-
Type of Ide 'fi ti // � CO r
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Type of Id tific do -• >. O
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ignature of Notary Public- St to f Florida) ml;
Signature of Notary Public- ate of Florida )
Commission No. (Seal) r
Commission No (Seal)°
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER _
. REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE'
RECEIVED
DATE
COMPLETED
ev. 2-17119