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
PERMIT'TYPE:
PR � PQSE ► 1 PR�t/ MF OCATlCl�
Address: 33 d 3_ e Cc 34 9 / 7
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
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: $ 4000 Utilities: —Sewer —Septic Building Height:
Name (ni I i
Name:
-Address: _ 3 3 0 3 4ve,wllff S.
Co
City:}-, �� C r c f, State: �
t'
Zip Code: 3 l L%'% . Fax:
Phone No.
,mpany:
_
Address ��t .t
�.
City: �4q,a, _totlhr3ae�1i5�`v�fY.. State:
Phone No -
E-Mail: dru WItJ1 V(-e� 1,<<J�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
IIIf 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.
P -MEN l CQN� T
CTIC3
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 LENDERORfAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
V9/, A V - �
Signa ure of Own r/ 19eWcontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA "
STATE OF FLORIDA
COUNTY OF �C9 �a r .p
COUNTY OF
The f rgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20\ by
this day of 20_ by
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
Produced
(Si na ure of Notary Pu ic- State of Florid
(Signature of Notary Public- State of Florida )
Commission No. IASHAHi � RAf1M
Commission No. (Seal)
' MY COMA 276006g0
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REVIEWS
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PERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW,
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z/ // 19