HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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: Q .A,. "
Address:
Property Tax ID #:% Lot No.
Block No.
.Site Plan Name:
Proiect Name""""'
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
_XElectric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ G dD OD
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
Address:
City: State,
Zip Code: Fax:_
Phone No. 6 D8- '73.7 - 8 •Sri,
E-Mail:ada
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: L�3
City: State: State:.' .
Zip Code: �y94.6 Fax: �i6/•-2 %7 �
Phone No #-61-.2277
E-Mail jOn,,'at`e 1 LA i - e4/ . co k"
State or County License lo'd /30Q - 595 `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.
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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: _2Chlot 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 YOUR LENDER 0111'AI1 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM fE CEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sig ture of Contra cctor/L cense Holder
STATE OF FLORIDA
OF O)
COUNTY OF ���(PSTATE
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COUNTY e
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The for oing instru nt was panowledged efore me
ty
The fo • oing instru��mppnt wa acknowledged before me
this day of GI/
20
this day of /L/w 201Q by
—
Natne of person making statement.
Na a of person making statement.
Personally, Known V OR Produced Identification
Personally Known I/-"�OR Produced Identification
Type of Identification
Type of Identification
Prodo-c-elk
( t I )OU,/P
Produced
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(Signature of Notary PW1i%_STATE(3E9kORI0A
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(Signature of Notary Public- Stat(boofNFInrida MM Prue
Commission No.
NOTARY PUBLICII
Commission No.&'NOTARY�,��
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Expires 1126/
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19