HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: Permit Number:
Planning and DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Applicati
Commercial Residential
Property Tax ID #: Lot No.
Site Plan Name: 01640aW 1' Block No.
Project Name:
i
Additional work to be performed under this permit — check all that pply:
Mechanical" Gas Tank.- Gas Piping Shutters _Windows/Doors
,Electric — '' i Plumbing Sprinklers — Generator`,-- Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7 5V Utilities: —Sewer _Septic Building Height:
OWNER/LESS 1E:
CONTRACT • R:
Name
Name: ,
Address:_ �� — i
City: -
Zip Code:30 �" Fax7%`
7
Phone No:7/n�. f
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-, ,__._ t State:
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s
Company: C h
Address: -O
City: Stater
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Zip Code: S� .<T7 . Fax:
Phone No,-
E-Mail: _
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
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.
DESIGNER/ENGINEER: ; . . _ Not Applicable
Name:_
Address:
City: =
Zip:
Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone:_
State
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: I Phone:.
Not"Applicable
State:
Not Applicable I 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 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 ATTORJNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of caner/ Le /tx trac s Agent for Owner
Signature of Con tracto
'ce aF(oFWc
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
I
C�
COUNTY OF
The for ing instru a �t was acknowledge efore me
thida f 20 by
The f r ng instrume t w s acknowledge before me
this,day of 20 by
Name of person ma inggss teme t.
Name o person making statement.
/
Personally Known i;/ OR Produced Identification
Personally Known L" .
OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sign ture of Not ublic- State o Florida)
(Signat re of
IVotar Pu
lic- State of Florida) -
"` , KAREN S. hjfibSEN
Commission ,. ��Y° B';, Il�y {{��
lorida Public
Commission
,,Moil,
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KAREN S. N4C�SI�N
Commissiori'# GG'207484
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lorida-N tary ublic
as
Commission # GG 207484
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June 12, 2022
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June 12, 2022
REVIEWS
VISOR
PLANS
ROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/ 19