HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST-BE-COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Sb�as�vk Permit Number: 1q� wfygG�
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y 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:
PROPOSED IMPROVEMENT LOCATION: -
Address _�//r��,2�/��%t 1AJ
Property Tax ID#: Lot No. I
Site Plan Name:�� �pl<l�oBlock No.a
Project Name:
DETAILED DESCRIPTION OF WORK:
FCONSTRU&ION INFORMATION:
Additional work to be performed under this permit-check all that apply:
�ilechanical _GasTank _Gas Piping —Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ SOD Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: .3/4a &�, ,r i�y ),4zle Company: C
City: SL State:,!5� Address: e
Zip Code: '�riS a- Fax: City: L State: /-:7_C_
PhoneNo. Zip Code: Y!j Ft Fax:
E-Mail: Phone No `��6�- ygf Oel:
Fill in fee simple Title Holder on next page(if different E-Mail .�-
from the Owner listed above) State or County License I"AC-1
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',CONSTR,UCTION LIENIAW I:NFORIVIATION
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.
-1 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 thepermit 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."
re of Owner/Lessee/Contractor as Agent for Owner ature of Contractor/License Holder
STATE OFFLORIDASTATE OF FLORIDA
COUNTY OF I&aC• COUNTY OF S j-.
The forgoing instrument was acknowledged before me The forgoing instrument-was.acknowledged before me
this aL' day of d¢zb 20'%*% by this day of QcE 20%� by
d-V� \ d1as-�.I g Qom+-N"k�-� ked. s•� gI2
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 L Produced
.(Signature of Notary . blic-State of Florida) (Signature ofNot
3 j�glil �+`��•
DEANNA` GG 0UO
CommissionNo.CrfrO'-�-C� ,+MA�IEQ23 ISSION#
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MY COMM1SS�U8ipbe�16,Y9�1199 . '� . oEXFIK
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REVIEWS FRONT "'-:E l PERVISOR PLANS VEGETATION -SEATURTLE -MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
.RECEIVED
DATE
COMPLETED
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