HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:T 1 \ Permit Number: ���1- (zJdLd
RECEIVED
1.,
COUNTY NOV 4
♦ R I R
Building Permit Applical fGnMcieCounty, Permi ng
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: _ S
PROPOSED IMPR01/EM ANT EOCATtON: ft
Address:
Property Tax ID#: " dNS4Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE�S�RI�PTION OF WORK:
D
C®NSTRUCTt m [NAM T!®N:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows D rs�-
_Electric _Plumbing _Spr1pyers _Generator --Roof Fitch
Total Sq. Ft of Construction: ® -` Sq. Ft. of ' st Floor: 6 `
Cost of Construction:$ �� Utilities: Sewer _Septic Building Height:
OWNER/LE:S 8EE. CONTRACTOR:
Name ( ,�-
Address. IU 4 ompany:
City: State. Address''
Zip Code: Fax: ity ' State:
r rr a
Phone No. "a-�— r u Zip'Code;'k' - Fax':
E-Mail: 1 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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.
UPP 10,AN
ANNIONN RU NARINNA1170,011R O
DESIGN .ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Addr Address:
City- tat City: State:
Zip- Phone �Y 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 YOU LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signaturi6 of Owner/Lessee/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA c STATE OF FLORIDA
COUNTY OF S4 L v c I (!!�_ COUNTY OF
The for ping instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of N ay ewr�i['✓,20 by this day of 20_ by
Name of person making state ent. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
T f tification Type of Identification
roduced Produced
( gnature of Notary Public-State of Florida (Signature of Notary Public State of Florida)
JO CN,,N�,I�HILLS,SR
Commission No.' = �: MY Cot SION#0031305 Commission No. (Seal)
.`: EXPIRES:July 18.2023
NA
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 217119