HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:ft
t ` Permit Number.
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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) 4624553 Fax: (772) 4624578
PERMIT TYPE.
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name.
DETAILED DESCRIPTION OF WORK.
CONSTRUCTION INFORMATION:
Commercial
WI
Residential
Lot No.
Block No.
Additional work to be performed under this permit — check all that apply.
Mechanical Gas Tank _ Gas Piping _, Shutters Windows/Doors
Electric Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ "I �� Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
Name
Address: ") n
City: v Cif 1 oCX I M.v+_
Zip Code: Fax;
Phone No.
&Mail:
CONTRACTOR:
Name.
�= Company:
Stater
Address:_
City•
Zip Code.
Phone No
Fill in fee simple Title Holder on neA page (if different I &Ma
from the Owner listed above)
State or Co
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.
State: F (..
Not Applicable
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name:
Address:
City: State:
Zip: _ Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
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 hermit holder to build the subject structure
which is in conflict with any applicable HomeOwners
Association and review your deed for any estrictions ts that wh which ay apply. obit such
structure. Please consult with your Home Owners
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
TRICE 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.
of Owner/
STATE OF FLORIDA
COUNTY OF
ractor as Agent for Owner so gnatuXof Contractor/License Hold
The f going instrumg t w c o ac ledge before me
this day of 20M by
Name of person making stateme
Personally Known d OR Produced Identification
Type of Identification
Produced
STATE OF FLORIDA
�� l
COUNTY OF
The f oing instrument was a kno ledged before me
this day of 20LO by
Name of person making statement.
Personally Known._ OR Produced Identification
Type of Identification
Produced
(Signature of Notary P�blic"5ta a, a LINDSEY BAKER (Sig ature of Notary Pur I OSEY BAKER
Notary Public • State of F oricaCommission NO. : �• teal Commission AGG 335 0�^ Notuy Public - State ort Florida
b ission No. "o` Com#" GG 335507'
`lost My Comm. Expires May 16 Q of moo' My Comm. Expires May 16. 2023
Bonded through National Not a Assr•, Bonded throw h National Notary A3sr,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED