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All 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
PERMIT TYPE: 11 1 I L
Address: �f L Q. f 1� �% r B'2J`C'Q- V L 3( 4 Yto
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:!
CC3 STRUCTION IN'FORMA ON -
Additional work to be performed under this permit —check all that apply:
_Mechanical — Gas Tank _ Gas Piping — Shutters Windows/ oors
Electric Plumbing —Sprinklers. Generator !/Roof Pitch
Total Sq. Ft of Construct'oin: -. vV S Sq. Ft. of First Floor:
Cost of Construction: sz �� Utilities: _ Sewer _ Septic Building Height:
MEMB . LESSEE.
tCONTRA TaR:
Name
4l
Name:
Address: i)
Com,pany:_ -
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City: State:
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;•r;;State:
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Zip Code: Fax:
Phone No.
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Phone No
E-Mail
Fill in fee 'simple Title Holder on next page ( i -different
E-Mail
State or County License
from the Owner listed above)
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'PPLEM.EE AL C(�NSTRaUCTION LLEN LAW INF�RMATf�N
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sig ature of?ter7_Ce_ssee/Contr4tor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ll
STATE OF FLORIDA
__
COUNTY OF ,
COUNTY OF
The for oing instrument ,was acknowled before me
09
The forgoing instrument was acknowledged before me
day 20_ by
this day of by
J. a., \ J\ ozz-
this of
Name of person rflaking statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
igna e o otaryublic- ate of Florida)
(Signature of Notary Public- State of Florida )
N�
Commission No. CG7
Commission No. (Seal)
' rrt tJ1Y C 2p, 2=
ets
REVIEWS
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FIR
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19